{ "hospital_name": "Pampa Regional Medical Center", "last_updated_on": "2026-03-17", "version": "3.0", "location_name": [ "Pampa Regional Medical Center" ], "hospital_address": [ "One Medical Plaza Pampa, TX 79065" ], "license_information": { "license_number": "455125687", "state": "TX" }, "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": "Jonathan Gill" }, "type_2_npi": [ "1700509577" ], "standard_charge_information": [ { "description": "IGE PISTACHIO NUT", "code_information": [ { "code": "86003", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 16.3, "discounted_cash": 3.0, "minimum": 2.445, "maximum": 352.08, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5.12, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.36 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 16.3 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 4.54 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.36 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 16.3 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 16.3 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 37.06, "10th_percentile": 37.06, "90th_percentile": 222.36, "count": "1 through 10" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7.83, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 7.31, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 5.53, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.61, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.81 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.31 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 9.3 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.36 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.72 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.61, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "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": "fee schedule", "standard_charge_dollar": 7.15 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 10.36, "10th_percentile": 10.36, "90th_percentile": 10.36, "count": "1 through 10" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 8.54 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.83, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "SHEATH 6FR 45CM, DESTINATION", "code_information": [ { "code": "C1894", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 112.23, "10th_percentile": 28.87, "90th_percentile": 279.68, "count": "37" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 99.92, "10th_percentile": 25.71, "90th_percentile": 152.65, "count": "26" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 94.66, "10th_percentile": 56.02, "90th_percentile": 112.23, "count": "11" } ] } ] }, { "description": "INJ PARAVERT F JNT L/S 1 LEV - 64493 - 722020", "code_information": [ { "code": "64493", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3295.68, "discounted_cash": 500.0, "minimum": 348.528, "maximum": 2636.544, "payers_information": [ { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 539.52, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 352.49, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 1080.03 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 576.56 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 1201.83 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 1201.83 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 539.52, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 503.55, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 381.26, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 593.47, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 377.66, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 377.66, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 593.47, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 359.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 359.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 359.68, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "CATH EVERCROSS EV3 6X30MM", "code_information": [ { "code": "C1725", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 462.76, "10th_percentile": 256.45, "90th_percentile": 2515.23, "count": "21" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 270.69, "10th_percentile": 106.59, "90th_percentile": 1342.29, "count": "14" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 484.0, "10th_percentile": 143.56, "90th_percentile": 543.74, "count": "1 through 10" } ] } ] }, { "description": "PATELLA ANATOMIC 20MM", "code_information": [ { "code": "C1776", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 4588.1, "10th_percentile": 1617.12, "90th_percentile": 11630.3, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 9120.0, "10th_percentile": 9120.0, "90th_percentile": 9120.0, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 8640.0, "10th_percentile": 8640.0, "90th_percentile": 9120.0, "count": "1 through 10" } ] } ] }, { "description": "RNP ANTIBODIES LC", "code_information": [ { "code": "86235", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 98.62, "discounted_cash": 38.0, "minimum": 3.5775, "maximum": 163.112, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17.57, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.3 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 72.44 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 15.6 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.3 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 80.51 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 80.51 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 224.63, "10th_percentile": 114.18, "90th_percentile": 411.41, "count": "1 through 10" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 26.9, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 25.1, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 19.01, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 89.78, "10th_percentile": 18.74, "90th_percentile": 147.23, "count": "1 through 10" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 29.58, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 18.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26.81 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 35.41 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 31.93 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.3 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 33.4 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 29.58, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.56 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 96.22, "10th_percentile": 18.74, "90th_percentile": 114.95, "count": "1 through 10" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 29.35 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 26.9, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "NUCL ACID DET MYCOPLSMA PNEUMO", "code_information": [ { "code": "87581", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 175.45, "discounted_cash": 35.0, "minimum": 26.3175, "maximum": 157.55, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 34.39, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 49.51 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 141.76 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 30.53 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 49.51 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 157.55 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 157.55 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 98.25, "10th_percentile": 98.25, "90th_percentile": 98.25, "count": "1 through 10" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 52.64, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 49.13, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 37.2, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 287.98, "10th_percentile": 287.98, "90th_percentile": 287.98, "count": "1 through 10" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 57.9, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 36.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 52.48 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 69.3 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 62.49 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 49.51 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 65.38 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 57.9, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 48.07 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 57.44 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 52.64, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "SCREW TITANIUM SHORT THREAD 4.", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "XR ABSCESS/FIST/SIN", "code_information": [ { "code": "76080", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1452.2, "discounted_cash": 275.0, "minimum": 217.7658, "maximum": 1452.2, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 217.77, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 682.16 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 1452.2 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 418.97 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 682.16 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1452.2 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 1452.2 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 333.32, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 311.09, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 235.54, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 366.65, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 233.32, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 723.09 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 954.76 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 233.32, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 860.98 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 682.16 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 900.71 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 366.65, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 222.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 662.29 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 222.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 222.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 381.49 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 333.32, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "PERITONEAL ADHESIOLYSIS - SOI : 2", "code_information": [ { "code": "2242", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 20910.99, "maximum": 22165.65, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 21783.62 } ] } ] }, { "description": "SCRW LCKNG STARDRIVE 2.4X12", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "PROTEIN S-FUNCTIONAL LC", "code_information": [ { "code": "85306", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 61.1, "discounted_cash": 16.0, "minimum": 9.165, "maximum": 68.79, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.01, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.62 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 61.1 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 13.33 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.62 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 61.1 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 61.1 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.98, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 21.45, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 16.24, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 25.28, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 16.09, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.92 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.26 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.09, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 27.29 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.62 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28.55 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 25.28, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.99 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 25.09 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 22.98, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "HOHN CATH 5FR SINGLE", "code_information": [ { "code": "C1751", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 298.58, "10th_percentile": 298.58, "90th_percentile": 298.58, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 298.58, "10th_percentile": 298.58, "90th_percentile": 298.58, "count": "1 through 10" } ] } ] }, { "description": "GRP PSYCH SUB HR(900)", "code_information": [ { "code": "90853", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 318.3, "discounted_cash": 60.0, "minimum": 40.4838, "maximum": 254.64, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 40.48, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 61.97, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 57.83, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 43.79, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 68.16, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 43.38, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 43.38, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 68.16, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 41.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 41.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 41.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 118.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 61.97, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "OTHER ESOPHAGEAL DISORDERS - SOI : 2", "code_information": [ { "code": "2432", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 8731.69, "maximum": 9255.59, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 9096.07 } ] } ] }, { "description": "SCREW CORTEX 3.5X30 MM", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "US FINE NEEDLE ASPIRATION ADDL", "code_information": [ { "code": "10006", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 510.25, "discounted_cash": 96.0, "minimum": 76.5375, "maximum": 408.2, "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 96.95, "10th_percentile": 96.95, "90th_percentile": 96.95, "count": "1 through 10" } ] } ] }, { "description": "MAJOR BILIARY TRACT PROCEDURES - SOI : 3", "code_information": [ { "code": "2613", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 52668.07, "maximum": 55828.15, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 54865.96 } ] } ] }, { "description": "CHRONIC KIDNEY DISEASE - SOI : 3", "code_information": [ { "code": "4703", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 13824.78, "maximum": 14654.27, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 14401.7 } ] } ] }, { "description": "EXT FIX BAR 5X150", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "4.5 BROAD PLATE", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "DEB SUBQ TISSUE 20 SQ CM/<", "code_information": [ { "code": "11042", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2767.5, "discounted_cash": 727.0, "minimum": 162.0038, "maximum": 3063.664, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 162.0, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 424.95 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 226.85 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 472.87 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 472.87 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 247.97, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 231.43, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 175.23, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 272.76, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 173.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 272.76, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 165.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 165.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 165.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 247.97, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "CORT SCREW 2319-54", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "NEONATE BIRTHWT >2499G W MAJOR CARDIOVASCULAR PROCEDURE - SOI : 1", "code_information": [ { "code": "6301", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 33836.15, "maximum": 35866.31, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 35248.16 } ] } ] }, { "description": "TIBIAL FIXED EMBASE SZ 3 RT", "code_information": [ { "code": "C1776", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 4588.1, "10th_percentile": 1617.12, "90th_percentile": 11630.3, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 9120.0, "10th_percentile": 9120.0, "90th_percentile": 9120.0, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 8640.0, "10th_percentile": 8640.0, "90th_percentile": 9120.0, "count": "1 through 10" } ] } ] }, { "description": "STENT PERIPHERAL ARTERY 7MMX39", "code_information": [ { "code": "C1874", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 4258.8, "10th_percentile": 4258.8, "90th_percentile": 4420.0, "count": "1 through 10" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1456.46, "10th_percentile": 975.0, "90th_percentile": 4680.0, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1444.95, "10th_percentile": 1444.95, "90th_percentile": 1444.95, "count": "1 through 10" } ] } ] }, { "description": "CORT SCREW 2319-26", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "HBSAG IMM ASSAY - G0499 - 862853", "code_information": [ { "code": "G0499", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 270.88, "minimum": 3.285, "maximum": 216.704, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 27.7, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 39.89 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 114.21 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 24.59 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 39.89 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 126.93 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 126.93 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 42.41, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 39.58, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 29.97, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 46.65, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 29.68, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 42.29 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 55.83 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.68, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 50.35 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 39.89 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 52.67 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 46.65, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 28.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 38.73 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 28.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 28.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 41.88 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 42.41, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "SCREW LOW PROFILE TI 4.5X30", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "SCREW IC NAIL PROTECTION", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "OTHER INFECTIOUS & PARASITIC DISEASES - SOI : 4", "code_information": [ { "code": "7244", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 40483.04, "maximum": 42912.03, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 42172.44 } ] } ] }, { "description": "ELECTROLYTE PANEL", "code_information": [ { "code": "80051", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 286.25, "discounted_cash": 54.0, "minimum": 6.0987, "maximum": 229.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.87, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.89 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 28.32 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 6.1 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.89 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 31.47 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 31.47 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 194.65, "10th_percentile": 194.65, "90th_percentile": 194.65, "count": "1 through 10" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.52, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 9.81, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 7.43, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11.57, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 7.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.48 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.84 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 12.48 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.89 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.06 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.57, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 7.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.6 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 7.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 11.48 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.52, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "SPC FOOT&ANKLE 514.315", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "XR SKULL MINIMUM 4 VIEWS", "code_information": [ { "code": "70260", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 608.3, "discounted_cash": 115.0, "minimum": 41.6598, "maximum": 503.24, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 41.66, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 135.95 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 452.8 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 97.51 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 135.95 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 503.24 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 503.24 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 63.77, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 59.51, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 45.06, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 70.14, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 44.64, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 144.11 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 190.28 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 44.64, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "QTC Medical Group", "plan_name": "QTC Medical Group", "methodology": "fee schedule", "standard_charge_dollar": 97.59 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 171.59 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 135.95 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 179.51 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 70.14, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 42.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 131.99 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 42.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 42.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 109.07 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 63.77, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "MALE REPRODUCTIVE SYSTEM DIAGNOSES EXCEPT MALIGNANCY - SOI : 3", "code_information": [ { "code": "5013", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 11791.56, "maximum": 12499.05, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 12283.63 } ] } ] }, { "description": "PACEMAKER IMP SGL CHAMBR", "code_information": [ { "code": "C1786", "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": 19.0, "median_amount": 4220.28, "10th_percentile": 4220.28, "90th_percentile": 4220.28, "count": "1 through 10" } ] } ] }, { "description": "ANTITHROMBIN ACTIVITY LC", "code_information": [ { "code": "85300", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 72.5, "discounted_cash": 13.0, "minimum": 10.3095, "maximum": 58.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11.61, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.73 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 47.87 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 10.31 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.73 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 53.21 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 53.21 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17.78, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 16.59, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 12.56, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.55, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.44, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.73 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.41 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.44, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 21.11 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.73 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.09 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.55, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.24 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 19.4 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.78, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "DILATION & CURETTAGE FOR NON-OBSTETRIC DIAGNOSES - SOI : 4", "code_information": [ { "code": "5174", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 48516.62, "maximum": 51427.62, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 50541.27 } ] } ] }, { "description": "RETICULOENDOTHELIAL AND IMMUNITY DISORDERS WITHOUT CCMCC", "code_information": [ { "code": "816", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 3052.0362, "maximum": 15762.6, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 5293.4 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 6058.98 } ] } ] }, { "description": "CATHETER RIO ASPIRATION", "code_information": [ { "code": "C1757", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 789.75, "10th_percentile": 416.2, "90th_percentile": 947.7, "count": "1 through 10" } ] } ] }, { "description": "ADRENAL AND PITUITARY PROCEDURES WITH CCMCC", "code_information": [ { "code": "614", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 11022.2424, "maximum": 23249.1, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 23249.1 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 21012.79 } ] } ] }, { "description": "THER/PROPH/DIAG IV INF ADDON(I", "code_information": [ { "code": "96366", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 219.84, "discounted_cash": 41.0, "minimum": 18.6592, "maximum": 274.8, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.66, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 59.57 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 19.12 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 66.16 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 66.16 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 28.56, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 26.66, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 20.18, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 274.8, "10th_percentile": 52.21, "90th_percentile": 1374.0, "count": "189" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 31.42, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 19.99, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.99, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 31.42, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 19.04, "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": 19.0, "median_amount": 156.64, "10th_percentile": 52.21, "90th_percentile": 574.33, "count": "49" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 19.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 19.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 156.64, "10th_percentile": 52.21, "90th_percentile": 703.71, "count": "40" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 219.84 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 28.56, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "BEHAVIORAL DISORDERS - SOI : 2", "code_information": [ { "code": "7582", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 4592.66, "maximum": 4868.22, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 4784.32 } ] } ] }, { "description": "FECAL FAT, QUALITATIVE", "code_information": [ { "code": "82705", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 25.0, "discounted_cash": 4.0, "minimum": 3.75, "maximum": 22.9, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5.0, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.2 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 20.6 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 4.44 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.2 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 22.9 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 22.9 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7.65, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 7.14, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 5.41, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.42, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.63 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.08 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 9.09 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.2 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.51 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.42, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.99 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 5.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 8.33 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.65, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "UTERINE AND ADNEXA PROCEDURES FOR OVARIAN OR ADNEXAL MALIGNANCY WITH MCC", "code_information": [ { "code": "736", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 19664.3676, "maximum": 56295.0, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 30917.2 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 34268.73 } ] } ] }, { "description": "Repair Wound of S/N/AX/GEN/TRK", "code_information": [ { "code": "12004", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 941.76, "discounted_cash": 178.0, "minimum": 79.9582, "maximum": 753.408, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 79.96, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 232.39 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 124.06 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 258.6 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 258.6 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 122.39, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 114.23, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 86.49, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 134.62, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 85.67, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.67, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 134.62, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 81.59, "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": 19.0, "median_amount": 178.93, "10th_percentile": 178.93, "90th_percentile": 178.93, "count": "1 through 10" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 81.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 81.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 200.97, "10th_percentile": 200.97, "90th_percentile": 200.97, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 122.39, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "I&D PILONIDAL CYST SIMPLE", "code_information": [ { "code": "10080", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1738.02, "discounted_cash": 330.0, "minimum": 117.36, "maximum": 1390.416, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 282.2, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 158.68 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 117.36 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 176.86 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 176.86 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 431.94, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 403.14, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 305.24, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 475.13, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 302.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 302.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 24.6, "median_amount": 222.9, "10th_percentile": 179.36, "90th_percentile": 222.9, "count": "1 through 10" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 475.13, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 287.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 287.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 287.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 431.94, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "CORTISOL TOTAL AM", "code_information": [ { "code": "82533", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 291.5, "discounted_cash": 55.0, "minimum": 14.181, "maximum": 233.2, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.97, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.0 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 65.85 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 14.18 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.0 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 73.19 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 73.19 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 180.2, "10th_percentile": 163.24, "90th_percentile": 198.22, "count": "1 through 10" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.45, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 22.82, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 17.28, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 55.39, "10th_percentile": 55.39, "90th_percentile": 55.39, "count": "1 through 10" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 26.9, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 17.12, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.38 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 32.19 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.12, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 29.03 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.0 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.37 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 26.9, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "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": "fee schedule", "standard_charge_dollar": 22.33 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 55.39, "10th_percentile": 16.3, "90th_percentile": 55.39, "count": "1 through 10" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 16.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 55.39, "10th_percentile": 52.47, "90th_percentile": 55.39, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 26.69 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 24.45, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "INTERSTITIAL & ALVEOLAR LUNG DISEASES - SOI : 3", "code_information": [ { "code": "1423", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 12946.17, "maximum": 13722.94, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 13486.43 } ] } ] }, { "description": "Hip Neurotomy Obturator Nerve", "code_information": [ { "code": "64640", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1802.61, "discounted_cash": 160.0, "minimum": 125.3, "maximum": 1802.608, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 352.49, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 169.42 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 125.3 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 188.83 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 188.83 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 539.52, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 503.55, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 381.26, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 593.47, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 377.66, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 377.66, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 593.47, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 359.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 359.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 359.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 539.52, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "DENTAL AND ORAL DISEASES WITHOUT CCMCC", "code_information": [ { "code": "159", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 3028.4844, "maximum": 15012.0, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 4983.83 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 6792.39 } ] } ] }, { "description": "OT ELECT STIM UNATTENED - G0283 - 201738", "code_information": [ { "code": "G0283", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 159.5, "minimum": 12.0932, "maximum": 127.6, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 39.08 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.55 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 43.4 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 43.4 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.51, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 17.28, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 13.08, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 20.36, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.96, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.96, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.36, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 12.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 79.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.51, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "STENT PERIPHERAL EVERFLEX 6X40", "code_information": [ { "code": "C1874", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 4258.8, "10th_percentile": 4258.8, "90th_percentile": 4420.0, "count": "1 through 10" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1456.46, "10th_percentile": 975.0, "90th_percentile": 4680.0, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1444.95, "10th_percentile": 1444.95, "90th_percentile": 1444.95, "count": "1 through 10" } ] } ] }, { "description": "DIRECT REFER HOSPITAL OBSERV", "code_information": [ { "code": "G0379", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3196.43, "minimum": 237.3364, "maximum": 3196.43, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 237.34, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 3034.0 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 2812.0 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 3196.43 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 3196.43 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 363.27, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 339.05, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 256.71, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 333.45, "10th_percentile": 333.45, "90th_percentile": 333.45, "count": "1 through 10" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 399.6, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 254.29, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 254.29, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 399.6, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 242.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 242.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 242.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 333.45, "10th_percentile": 333.45, "90th_percentile": 333.45, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 2122.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 363.27, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "NEONATE BWT 1500-1999G W RESP DIST SYNDOTH MAJ RESP COND - SOI : 1", "code_information": [ { "code": "6121", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 26062.33, "maximum": 27626.07, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 27149.94 } ] } ] }, { "description": "STENT EVERFLEX TRIAXLE 6X120MM", "code_information": [ { "code": "C1876", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 3100.8, "10th_percentile": 1880.29, "90th_percentile": 7522.24, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 3482.69, "10th_percentile": 3482.69, "90th_percentile": 3482.69, "count": "1 through 10" } ] } ] }, { "description": "REPAIR INTERMEDIATE WOUND 12.6", "code_information": [ { "code": "12055", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1597.7, "discounted_cash": 303.0, "minimum": 162.0038, "maximum": 1278.16, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 162.0, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 424.95 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 226.85 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 472.87 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 472.87 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 247.97, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 231.43, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 175.23, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 272.76, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 173.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 272.76, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 165.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 165.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 165.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 247.97, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "CATH EV3 EVERCROSS 6X40MM", "code_information": [ { "code": "C1725", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 256.5, "10th_percentile": 256.5, "90th_percentile": 288.09, "count": "1 through 10" } ] } ] }, { "description": "INJECTION IM/SEBQ", "code_information": [ { "code": "96372", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 337.32, "discounted_cash": 64.0, "minimum": 28.6944, "maximum": 269.856, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 75.0, "median_amount": 252.99, "10th_percentile": 210.31, "90th_percentile": 252.99, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 28.69, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 163.87 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 52.61 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 182.01 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 182.01 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 43.92, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 40.99, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 31.04, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 184.33, "10th_percentile": 99.34, "90th_percentile": 338.73, "count": "1 through 10" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 71.98, "10th_percentile": 59.84, "90th_percentile": 337.32, "count": "184" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 48.31, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 30.74, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30.74, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange EPO/HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 27.55, "median_amount": 252.99, "10th_percentile": 252.99, "90th_percentile": 252.99, "count": "1 through 10" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 48.31, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 29.28, "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": 19.0, "median_amount": 64.09, "10th_percentile": 64.09, "90th_percentile": 64.09, "count": "59" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 29.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 29.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 64.09, "10th_percentile": 60.72, "90th_percentile": 71.98, "count": "21" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 43.92, "additional_payer_notes": "150.00% 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", "minimum": 4021.3544, "maximum": 21016.8, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 6289.65 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 8585.16 } ] } ] }, { "description": "PTH INTACT", "code_information": [ { "code": "83970", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 415.12, "discounted_cash": 78.0, "minimum": 35.9136, "maximum": 332.096, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 40.45, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 58.26 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 166.77 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 35.91 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 58.26 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 185.35 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 185.35 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 282.28, "10th_percentile": 232.47, "90th_percentile": 282.28, "count": "1 through 10" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 61.92, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 57.79, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 43.76, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 78.87, "10th_percentile": 74.72, "90th_percentile": 88.59, "count": "18" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 68.11, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 43.34, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 61.75 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 81.54 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 43.34, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 73.53 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 58.26 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 76.92 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 68.11, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "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": "fee schedule", "standard_charge_dollar": 56.56 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 78.87, "10th_percentile": 78.87, "90th_percentile": 78.87, "count": "23" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 41.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 41.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 78.87, "10th_percentile": 74.72, "90th_percentile": 88.59, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 67.57 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 61.92, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "STREP A AG IA", "code_information": [ { "code": "87430", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 131.0, "discounted_cash": 24.0, "minimum": 14.6247, "maximum": 104.8, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 16.47, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.72 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 67.91 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 14.62 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.72 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 75.48 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 75.48 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 25.22, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 23.53, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 17.82, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 27.74, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 17.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.14 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 33.2 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 29.94 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.72 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.32 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 27.74, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 16.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.03 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 16.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 19.63 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 25.22, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "SCREW LOCKING SLF-TPNG 2.7X28M", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "SCREW CANNULATED 65 MM", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "OTHER INJURY, POISONING & TOXIC EFFECT DIAGNOSES - SOI : 2", "code_information": [ { "code": "8152", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 8130.03, "maximum": 8617.84, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 8469.31 } ] } ] }, { "description": "PICC INSERTION", "code_information": [ { "code": "36569", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3097.6, "discounted_cash": 588.0, "minimum": 434.874, "maximum": 5890.144, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 627.35, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 2169.4 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 1158.1 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 2414.07 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 2414.07 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 960.23, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 896.21, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 678.56, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1056.25, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 672.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 672.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1056.25, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 640.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 640.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 640.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 960.23, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "JOURNEY ART INSERT SM1-2", "code_information": [ { "code": "C1776", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 4588.1, "10th_percentile": 1617.12, "90th_percentile": 11630.3, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 9120.0, "10th_percentile": 9120.0, "90th_percentile": 9120.0, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 8640.0, "10th_percentile": 8640.0, "90th_percentile": 9120.0, "count": "1 through 10" } ] } ] }, { "description": "STANDARD FEMORAL STEM SZ 6", "code_information": [ { "code": "C1776", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 4588.1, "10th_percentile": 1617.12, "90th_percentile": 11630.3, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 9120.0, "10th_percentile": 9120.0, "90th_percentile": 9120.0, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 8640.0, "10th_percentile": 8640.0, "90th_percentile": 9120.0, "count": "1 through 10" } ] } ] }, { "description": "NEONATE BIRTHWT 750-999G WO MAJOR PROCEDURE - SOI : 3", "code_information": [ { "code": "5933", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 137949.86, "maximum": 146226.85, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 143706.64 } ] } ] }, { "description": "FOGARTY IRRIGATION CATH6", "code_information": [ { "code": "C1757", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 789.75, "10th_percentile": 416.2, "90th_percentile": 947.7, "count": "1 through 10" } ] } ] }, { "description": "VAC CANISTER", "code_information": [ { "code": "A6550", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 103.0, "minimum": 15.45, "maximum": 82.4, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 69.5 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 23.9 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 77.19 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 77.19 } ] } ] }, { "description": "ER DRAIN ABSC/HEMA EAR EXT SMP", "code_information": [ { "code": "69000", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3050.05, "discounted_cash": 579.0, "minimum": 92.5, "maximum": 2440.04, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 282.2, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 125.07 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 92.5 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 139.4 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 139.4 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 431.94, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 403.14, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 305.24, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 475.13, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 302.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 302.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 475.13, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 287.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 287.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 287.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 431.94, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "CATH NANOCROSS EV3 ELITE 4-3.5", "code_information": [ { "code": "C1725", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 462.76, "10th_percentile": 256.45, "90th_percentile": 2515.23, "count": "21" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 270.69, "10th_percentile": 106.59, "90th_percentile": 1342.29, "count": "14" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 484.0, "10th_percentile": 143.56, "90th_percentile": 543.74, "count": "1 through 10" } ] } ] }, { "description": "CLAVICAL PLATE 3.5LCP 5H/RT/94", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "HEMODIALYSIS ONE EVAL IP", "code_information": [ { "code": "90935", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3271.7, "discounted_cash": 621.0, "minimum": 273.518, "maximum": 2617.36, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 273.52, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 418.65, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 390.74, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 295.85, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 460.52, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 293.06, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 293.06, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 460.52, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 279.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 279.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 279.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 418.65, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "PT NPWT <50CM 45MIN - 97605 - 972020", "code_information": [ { "code": "97605", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1035.93, "discounted_cash": 77.0, "minimum": 45.315, "maximum": 900.0, "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 196.83, "10th_percentile": 108.48, "90th_percentile": 663.21, "count": "22" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 134.62, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 85.67, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.67, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 134.62, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 81.59, "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": 19.0, "median_amount": 196.83, "10th_percentile": 196.83, "90th_percentile": 196.83, "count": "1 through 10" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 81.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 81.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 186.47, "10th_percentile": 106.25, "90th_percentile": 196.83, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 122.39, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 79.96, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 473.52 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 152.02 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 525.94 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 525.94 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 122.39, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 114.23, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 86.49, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 1895.25, "10th_percentile": 731.62, "90th_percentile": 2268.2, "count": "1 through 10" } ] } ] }, { "description": "MOD SED SAME PHYS/QHP EA AD15M", "code_information": [ { "code": "99153", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 222.0, "discounted_cash": 42.0, "minimum": 9.4047, "maximum": 244.2, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 29.3 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 9.4 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 32.54 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 32.54 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 188.7, "10th_percentile": 188.7, "90th_percentile": 341.88, "count": "1 through 10" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 59.22, "10th_percentile": 58.0, "90th_percentile": 195.42, "count": "31" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 24.6, "median_amount": 71.97, "10th_percentile": 71.97, "90th_percentile": 71.97, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 58.0, "10th_percentile": 58.0, "90th_percentile": 231.99, "count": "18" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 65.14, "10th_percentile": 54.95, "90th_percentile": 116.0, "count": "1 through 10" } ] } ] }, { "description": "XR AC JNTS BI W/WO WT", "code_information": [ { "code": "73050", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 480.94, "discounted_cash": 91.0, "minimum": 34.6822, "maximum": 384.752, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 34.68, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 112.36 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 322.43 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 69.43 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 112.36 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 358.35 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 358.35 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 269.33, "10th_percentile": 269.33, "90th_percentile": 327.04, "count": "1 through 10" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 53.09, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 49.55, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 37.51, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 58.39, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 37.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 119.1 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 157.26 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 37.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 141.82 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 112.36 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 148.36 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 58.39, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 35.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 109.09 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 91.38, "10th_percentile": 91.38, "90th_percentile": 91.38, "count": "1 through 10" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 35.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 35.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 68.82 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 53.09, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "ESTIM UNATT CHRONIC WOUND", "code_information": [ { "code": "G0281", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 145.0, "minimum": 11.1622, "maximum": 116.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 101.0 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 93.0 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 112.0 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 112.0 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17.09, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 15.95, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 12.07, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.79, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 11.96, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.96, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.79, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 11.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 11.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.09, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "CATH EVERCROSS EV3 4MMX150MM", "code_information": [ { "code": "C1725", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 462.76, "10th_percentile": 256.45, "90th_percentile": 2515.23, "count": "21" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 270.69, "10th_percentile": 106.59, "90th_percentile": 1342.29, "count": "14" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 484.0, "10th_percentile": 143.56, "90th_percentile": 543.74, "count": "1 through 10" } ] } ] }, { "description": "CYSTIC FIBROSIS - PULMONARY DISEASE - SOI : 3", "code_information": [ { "code": "1313", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 37161.5, "maximum": 39391.2, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 38712.29 } ] } ] }, { "description": "ORTHO DISTAL RADIUSCLAMP", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "ANGIOGRAPHY EXTREMITY UNILAT", "code_information": [ { "code": "75710", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6623.21, "discounted_cash": 1258.0, "minimum": 993.4815, "maximum": 6623.21, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1258.34, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3941.43 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 6623.21 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2411.01 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3941.43 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 6623.21 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 6623.21 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1926.03, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 1797.63, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 1361.06, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1258.41, "10th_percentile": 1258.41, "90th_percentile": 1413.39, "count": "1 through 10" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2118.63, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1348.22, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4177.91 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5516.47 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1348.22, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 4974.62 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3941.43 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5204.22 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2118.63, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1284.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3826.63 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1258.41, "10th_percentile": 1258.41, "90th_percentile": 1258.41, "count": "1 through 10" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1284.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 1284.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 3091.73 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1926.03, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "CATH NC TREK DILATION 3.0X12MM", "code_information": [ { "code": "C1725", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 462.76, "10th_percentile": 256.45, "90th_percentile": 2515.23, "count": "21" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 270.69, "10th_percentile": 106.59, "90th_percentile": 1342.29, "count": "14" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 484.0, "10th_percentile": 143.56, "90th_percentile": 543.74, "count": "1 through 10" } ] } ] }, { "description": "ACUTE LEUKEMIA WITHOUT MAJOR O.R. PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "836", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 5401.2128, "maximum": 18014.4, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 12061.9 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 11691.35 } ] } ] }, { "description": "24MM CORTEX SCREW 40MM", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "OPIATES QL SQL", "code_information": [ { "code": "80299", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 25.0, "discounted_cash": 34.0, "minimum": 3.0, "maximum": 340.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.27, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.0 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 25.0 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 16.22 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.0 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 25.0 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 25.0 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 25.0, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 25.0, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 19.76, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 87.74, "10th_percentile": 52.01, "90th_percentile": 104.02, "count": "1 through 10" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 25.0, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 19.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.0 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.0 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 25.0 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.0 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.0 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 25.0, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 18.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.0 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 18.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 104.02, "10th_percentile": 104.02, "90th_percentile": 104.02, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 22.42 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 25.0, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "GASTRIC EMPTYING IMAG STUDY", "code_information": [ { "code": "78264", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2410.38, "discounted_cash": 457.0, "minimum": 159.3186, "maximum": 1928.304, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 159.32, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 504.43 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 1244.85 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 268.07 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 504.43 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1383.5 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 1383.5 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 1349.81, "10th_percentile": 1349.81, "90th_percentile": 1639.06, "count": "1 through 10" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 243.86, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 227.6, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 172.32, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 1119.11, "10th_percentile": 1119.11, "90th_percentile": 1119.11, "count": "1 through 10" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 268.24, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 170.7, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 534.7 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 706.01 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 170.7, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 636.66 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 504.43 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 666.05 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 268.24, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 162.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 489.74 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 162.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 162.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 388.54 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 243.86, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "DECADRON - 63323016516", "drug_information": { "unit": 1.0, "type": "ML" }, "code_information": [ { "code": "63323016516", "type": "NDC" }, { "code": "J1100", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 75.0, "median_amount": 10.2, "10th_percentile": 10.2, "90th_percentile": 10.2, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 7.62, "10th_percentile": 4.68, "90th_percentile": 9.25, "count": "21" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 2.58, "10th_percentile": 1.24, "90th_percentile": 3.69, "count": "52" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange EPO/HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 27.55, "median_amount": 1.54, "10th_percentile": 1.54, "90th_percentile": 1.54, "count": "1 through 10" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 24.6, "median_amount": 1.2, "10th_percentile": 0.56, "90th_percentile": 1.84, "count": "35" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 2.58, "10th_percentile": 1.31, "90th_percentile": 2.58, "count": "36" } ] } ] }, { "description": "STENT RESOLUTE ONYX 4.0X38MM", "code_information": [ { "code": "C1874", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 4258.8, "10th_percentile": 4258.8, "90th_percentile": 4420.0, "count": "1 through 10" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1456.46, "10th_percentile": 975.0, "90th_percentile": 4680.0, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1444.95, "10th_percentile": 1444.95, "90th_percentile": 1444.95, "count": "1 through 10" } ] } ] }, { "description": "SCREW QUAD SPARING 33MM", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "TITANIUM ELASTIC NAIL", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "FASTFIX CURVED NEEDLE AS", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "BLOOD TYPING ABO - 86900 - 860809", "code_information": [ { "code": "86900", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 95.0, "discounted_cash": 3.0, "minimum": 2.616, "maximum": 104.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 53.02, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.22 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 95.0 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 94.86 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.22 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 95.0 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 95.0 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 31.35, "10th_percentile": 15.68, "90th_percentile": 58.52, "count": "1 through 10" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 81.15, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 75.74, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 57.35, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 20.27, "10th_percentile": 18.81, "90th_percentile": 60.82, "count": "16" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 89.27, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 56.81, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.48 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.91 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 56.81, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 5.33 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.22 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.58 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 89.27, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 54.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.1 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 19.86, "10th_percentile": 19.86, "90th_percentile": 39.71, "count": "17" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 54.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 54.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 22.3, "10th_percentile": 18.81, "90th_percentile": 37.62, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 4.88 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 81.15, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "OTHER SKIN, SUBCUTANEOUS TISSUE & BREAST DISORDERS - SOI : 1", "code_information": [ { "code": "3851", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 5012.87, "maximum": 5313.64, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 5222.06 } ] } ] }, { "description": "KEPPRA/LEVITISACETAN(REF)", "code_information": [ { "code": "80177", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 116.49, "discounted_cash": 22.0, "minimum": 11.5275, "maximum": 205.504, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12.99, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.69 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 53.53 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 11.53 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.69 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 59.49 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 59.49 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.88, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 18.55, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 14.05, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 22.13, "10th_percentile": 22.13, "90th_percentile": 22.13, "count": "1 through 10" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.86, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 13.91, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.82 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26.17 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.91, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 23.6 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.69 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.68 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.86, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.15 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 13.25, "10th_percentile": 13.25, "90th_percentile": 13.25, "count": "1 through 10" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 21.71 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.88, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "CANCELLOUS SCREWS", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "CATH BALLOON NANOCROSS3.5X150M", "code_information": [ { "code": "C1725", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 462.76, "10th_percentile": 256.45, "90th_percentile": 2515.23, "count": "21" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 270.69, "10th_percentile": 106.59, "90th_percentile": 1342.29, "count": "14" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 484.0, "10th_percentile": 143.56, "90th_percentile": 543.74, "count": "1 through 10" } ] } ] }, { "description": "COAGULATION & PLATELET DISORDERS - SOI : 4", "code_information": [ { "code": "6614", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 71259.32, "maximum": 75534.88, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 74233.04 } ] } ] }, { "description": "Fungus Culture, Yeast ID(REF)", "code_information": [ { "code": "87102", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 266.63, "discounted_cash": 42.0, "minimum": 7.3167, "maximum": 213.304, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.24, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.87 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 33.98 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 7.32 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.87 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 37.76 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 37.76 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12.62, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 11.77, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 8.91, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 13.88, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 8.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.58 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.61 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 14.98 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.87 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.67 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.88, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 8.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.52 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 8.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 13.75 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.62, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "NEONATE BIRTHWT >2499G W CONGENITALPERINATAL INFECTION - SOI : 2", "code_information": [ { "code": "6362", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 11858.41, "maximum": 12569.91, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 12353.27 } ] } ] }, { "description": "SICKLE CELL SCREEN", "code_information": [ { "code": "85660", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 121.25, "discounted_cash": 23.0, "minimum": 4.7937, "maximum": 97.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5.4, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.78 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 22.26 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 4.79 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.78 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 24.74 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 24.74 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.27, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 7.71, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 5.84, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9.09, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.24 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.88 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 9.82 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.78 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.27 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.09, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.55 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 5.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 9.04 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.27, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "GONORRHEA <21", "code_information": [ { "code": "87591", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 35.09, "discounted_cash": 6.0, "minimum": 5.2635, "maximum": 201.216, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 34.39, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 35.09 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 35.09 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 30.53 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 35.09 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 35.09 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 35.09 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 140.85, "10th_percentile": 140.85, "90th_percentile": 140.85, "count": "1 through 10" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 35.09 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 35.09 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 35.09 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 35.09 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 35.09 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 35.09 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 35.09 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "CYTOPATH C/V TLP AUTO/MAN LC", "code_information": [ { "code": "88175", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 115.15, "discounted_cash": 21.0, "minimum": 17.2725, "maximum": 115.15, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 26.08, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 37.55 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 107.5 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 23.15 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 37.55 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 115.15 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 115.15 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 39.92, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 37.25, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 28.21, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 43.91, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 27.94, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 39.81 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 52.56 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.94, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 47.4 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 37.55 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 49.59 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 43.91, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 26.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 36.46 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 26.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 26.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 43.37 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 39.92, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "CARDIAC VALVE PROCEDURES W AMI OR COMPLEX PDX - SOI : 2", "code_information": [ { "code": "1622", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 75842.44, "maximum": 80392.98, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 79007.41 } ] } ] }, { "description": "MRI UP JNT W/O CONT-LT - 73221 - 705513", "code_information": [ { "code": "73221", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3998.75, "discounted_cash": 759.0, "minimum": 95.0796, "maximum": 3212.12, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 95.08, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 303.0 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 941.48 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 202.74 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 303.0 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1046.35 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 1046.35 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 2239.3, "10th_percentile": 2239.3, "90th_percentile": 3415.43, "count": "1 through 10" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 145.53, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 135.83, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 102.84, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 1199.63, "10th_percentile": 1199.63, "90th_percentile": 2499.0, "count": "1 through 10" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 759.76, "10th_percentile": 719.78, "90th_percentile": 1071.84, "count": "12" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 160.08, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 101.87, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 321.17 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 424.08 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 101.87, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 382.42 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 303.0 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 400.07 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 160.08, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 97.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 294.17 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 759.76, "10th_percentile": 759.76, "90th_percentile": 759.76, "count": "1 through 10" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 97.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 97.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 719.78, "10th_percentile": 719.78, "90th_percentile": 719.78, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 353.74 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 145.53, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "BIPOLAR DISORDERS - SOI : 3", "code_information": [ { "code": "7533", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 11436.29, "maximum": 12122.47, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 11913.54 } ] } ] }, { "description": "Cervicool 2nd Level Rhizotomy", "code_information": [ { "code": "64633", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3364.11, "discounted_cash": 639.0, "minimum": 504.6165, "maximum": 2691.288, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 778.21, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 2286.74 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 1220.74 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 2544.64 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 2544.64 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1191.14, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 1111.73, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 841.74, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1310.25, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 833.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 833.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1310.25, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 794.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 794.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 794.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1191.14, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "CESAREAN SECTION WITHOUT STERILIZATION WITHOUT CCMCC", "code_information": [ { "code": "788", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 7165.0, "maximum": 21767.4, "payers_information": [ { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 8500.0, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 8495.95 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 7165.0 } ] } ] }, { "description": "VIRAL ILLNESS WITHOUT MCC", "code_information": [ { "code": "866", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 3866.1896, "maximum": 20266.2, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 5017.19 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 8336.86 } ] } ] }, { "description": "NON-EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS- SOI : 2", "code_information": [ { "code": "9522", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 16432.93, "maximum": 17418.9, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 17118.69 } ] } ] }, { "description": "VOLAR DISTAL RADIUSPLATE", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "SCREW CANNULATED 4.0X50MM", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "MULTIPLE SCLEROSIS, OTHER DEMYELINATING DISEASE AND INFLAMMATORY NEUROPATHIES- SOI : 3", "code_information": [ { "code": "0433", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 56232.18, "maximum": 59606.11, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 58578.8 } ] } ] }, { "description": "Optx gr hmrl tbrs fx int fix", "code_information": [ { "code": "23630", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7953.75, "discounted_cash": 1511.0, "minimum": 1193.0625, "maximum": 7953.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2891.8, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 7953.75 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 4247.18 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 7953.75 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 7953.75 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4426.23, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 4131.15, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 3127.87, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4868.85, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3098.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3098.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4868.85, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2950.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2950.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 2950.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4426.23, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "CATH DILATION POWERFLEX 7X40", "code_information": [ { "code": "C1725", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 462.76, "10th_percentile": 256.45, "90th_percentile": 2515.23, "count": "21" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 270.69, "10th_percentile": 106.59, "90th_percentile": 1342.29, "count": "14" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 484.0, "10th_percentile": 143.56, "90th_percentile": 543.74, "count": "1 through 10" } ] } ] }, { "description": "US THORA/PARA", "code_information": [ { "code": "76942", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1155.94, "discounted_cash": 219.0, "minimum": 21.9501, "maximum": 1017.224, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 101.93 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 21.95 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 113.28 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 113.28 } ] } ] }, { "description": "PELVIC EVISCERATION, RADICAL HYSTERECTOMY & OTHER RADICAL GYN PROCS - SOI : 4", "code_information": [ { "code": "5104", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 66570.21, "maximum": 70564.42, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 69348.24 } ] } ] }, { "description": "B TYPE NATRIURETIC PEPT", "code_information": [ { "code": "83880", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 361.69, "discounted_cash": 68.0, "minimum": 34.1562, "maximum": 289.352, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 75.0, "median_amount": 246.61, "10th_percentile": 246.61, "90th_percentile": 271.27, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 38.47, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 55.4 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 158.61 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 34.16 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 55.4 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 176.28 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 176.28 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 223.59, "10th_percentile": 202.55, "90th_percentile": 245.95, "count": "27" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 58.89, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 54.96, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 41.62, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 68.72, "10th_percentile": 54.25, "90th_percentile": 77.18, "count": "258" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 64.78, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 41.22, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 58.73 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 77.54 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 41.22, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 69.93 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 55.4 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 73.15 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 64.78, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "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": "fee schedule", "standard_charge_dollar": 53.79 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 68.72, "10th_percentile": 39.26, "90th_percentile": 68.72, "count": "201" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 39.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 39.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 68.72, "10th_percentile": 65.1, "90th_percentile": 77.18, "count": "86" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 55.57 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 58.89, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "TOMO MAMMO SCREEN--LT", "code_information": [ { "code": "77063", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 176.0, "discounted_cash": 47.0, "minimum": 11.6175, "maximum": 200.8, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 75.0, "median_amount": 188.25, "10th_percentile": 188.25, "90th_percentile": 188.25, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 21.75, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 101.93 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 21.95 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 113.28 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 113.28 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 140.56, "10th_percentile": 105.32, "90th_percentile": 170.68, "count": "29" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 33.29, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 31.07, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 23.52, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 75.3, "10th_percentile": 46.46, "90th_percentile": 75.3, "count": "43" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 49.05, "10th_percentile": 49.05, "90th_percentile": 128.68, "count": "80" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 36.61, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 23.3, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.3, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 36.61, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 22.19, "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": 19.0, "median_amount": 47.69, "10th_percentile": 47.69, "90th_percentile": 47.69, "count": "59" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 22.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 22.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 22.19 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 30.94 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 33.29, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "CATHETER GUIDE 4 EBU 5FR", "code_information": [ { "code": "C1725", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 462.76, "10th_percentile": 256.45, "90th_percentile": 2515.23, "count": "21" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 270.69, "10th_percentile": 106.59, "90th_percentile": 1342.29, "count": "14" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 484.0, "10th_percentile": 143.56, "90th_percentile": 543.74, "count": "1 through 10" } ] } ] }, { "description": "CANC SCREW 206.", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "MESH PHASIX ST 7CMX10CN", "code_information": [ { "code": "C1781", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1862.28, "10th_percentile": 1862.28, "90th_percentile": 11852.02, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1206.78, "10th_percentile": 1206.78, "90th_percentile": 1206.78, "count": "1 through 10" } ] } ] }, { "description": "PERITONEAL ADHESIOLYSIS WITH CC", "code_information": [ { "code": "336", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 10542.4322, "maximum": 40532.4, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 16226.5 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 20216.11 } ] } ] }, { "description": "CARDIOMYOPATHY - SOI : 1", "code_information": [ { "code": "2051", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 6681.28, "maximum": 7082.15, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 6960.09 } ] } ] }, { "description": "PORPHYRINS UR QUAL", "code_information": [ { "code": "84119", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 148.0, "discounted_cash": 28.0, "minimum": 11.6232, "maximum": 118.4, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13.09, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.85 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 53.97 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 11.62 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.85 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 59.99 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 59.99 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 20.04, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 18.7, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 14.16, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 22.04, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 14.03, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.98 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26.38 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.03, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 23.79 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.85 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.89 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 22.04, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 13.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.3 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 13.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 14.1 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 20.04, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "SCREW CAPTURED GOLD 5X30", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "XR FINGER(S)2+V-RT", "code_information": [ { "code": "73140", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 459.05, "discounted_cash": 87.0, "minimum": 34.6822, "maximum": 367.24, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 34.68, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 112.36 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 322.43 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 69.43 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 112.36 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 358.35 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 358.35 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 257.07, "10th_percentile": 257.07, "90th_percentile": 257.55, "count": "1 through 10" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 53.09, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 49.55, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 37.51, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 137.72, "10th_percentile": 113.63, "90th_percentile": 137.72, "count": "1 through 10" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 87.22, "10th_percentile": 66.56, "90th_percentile": 97.96, "count": "1 through 10" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 58.39, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 37.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 119.1 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 157.26 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 37.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 141.82 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 112.36 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 148.36 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 58.39, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 35.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 109.09 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 87.22, "10th_percentile": 87.22, "90th_percentile": 87.22, "count": "1 through 10" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 35.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 35.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 97.96, "10th_percentile": 97.96, "90th_percentile": 97.96, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 68.82 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 53.09, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "RPR S/N/AX/GEN/TRNK2.6-7.5CM - 12002 - 051872", "code_information": [ { "code": "12002", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1795.5, "discounted_cash": 341.0, "minimum": 79.9582, "maximum": 1436.4, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 79.96, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 232.39 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 124.06 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 258.6 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 258.6 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 122.39, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 114.23, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 86.49, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 134.62, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 85.67, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.67, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 134.62, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 81.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 81.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 81.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "percent of total billed charges", "standard_charge_percentage": 54.8, "median_amount": 2452.7, "10th_percentile": 2452.7, "90th_percentile": 2452.7, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 122.39, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "Renal Morphology", "code_information": [ { "code": "78700", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1540.0, "discounted_cash": 292.0, "minimum": 134.8239, "maximum": 1232.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 159.32, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 504.43 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 626.08 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 134.82 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 504.43 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 695.82 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 695.82 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 243.86, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 227.6, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 172.32, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 268.24, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 170.7, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 534.7 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 706.01 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 170.7, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 636.66 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 504.43 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 666.05 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 268.24, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 162.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 489.74 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 162.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 162.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 500.42 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 243.86, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "EBV AB VCA,IGG(REF)", "code_information": [ { "code": "86665", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 46.69, "discounted_cash": 36.0, "minimum": 7.0035, "maximum": 152.904, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17.78, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.61 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 46.69 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 15.78 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.61 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 46.69 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 46.69 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 27.21, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 25.4, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 19.23, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 29.93, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 19.05, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.14 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 35.84 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.05, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 32.32 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.61 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 33.81 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 29.93, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 18.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.86 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 18.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 29.7 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 27.21, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "ROCKY MTN SPOTTED FEVER, IGG L", "code_information": [ { "code": "86757", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 44.9, "discounted_cash": 18.0, "minimum": 6.735, "maximum": 86.88, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.96, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.31 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 44.9 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 16.83 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.31 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 44.9 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 44.9 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 29.03, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 27.09, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 20.51, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 31.93, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 20.32, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28.94 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 38.22 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.32, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 34.46 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.31 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 36.05 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 31.93, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 19.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26.51 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 19.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 19.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 31.68 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 29.03, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "ANGIO SELECT EA ADDTÆL VESSEL", "code_information": [ { "code": "75774", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2910.65, "discounted_cash": 553.0, "minimum": 57.6897, "maximum": 2328.52, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 267.89 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 57.69 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 297.73 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 297.73 } ] } ] }, { "description": "SUSC MIC NEG PANEL/MICROB SUSC", "code_information": [ { "code": "87186", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 191.99, "discounted_cash": 31.0, "minimum": 7.5255, "maximum": 153.592, "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 34.56, "10th_percentile": 8.65, "90th_percentile": 40.97, "count": "109" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.27, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 9.08, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.94 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.08 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.08, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 15.41 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.21 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.12 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.27, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.85 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 8.65, "10th_percentile": 8.65, "90th_percentile": 36.48, "count": "150" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 36.48, "10th_percentile": 17.3, "90th_percentile": 40.97, "count": "34" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 14.16 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.98, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 75.0, "median_amount": 143.99, "10th_percentile": 126.02, "90th_percentile": 143.99, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.48, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.21 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 34.95 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 7.53 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.21 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 38.84 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 38.84 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 107.51, "10th_percentile": 103.87, "90th_percentile": 130.55, "count": "18" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12.98, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 9.17, "additional_payer_notes": "106.00% of Medicare Rates" } ] } ] }, { "description": "PLATE TIBIA SMALL BEND 4HL 3.5", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "O.R. PROCEDURES FOR OBESITY WITH CC", "code_information": [ { "code": "620", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 6750.0, "maximum": 16325.397, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 14569.3 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 15342.08 } ] } ] }, { "description": "Rpr aa hrn 1st < 3 ncr/strn", "code_information": [ { "code": "49592", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4065.25, "discounted_cash": 772.0, "minimum": 609.7875, "maximum": 4065.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2409.3, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 4065.25 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 3700.63 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 4065.25 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 4065.25 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3687.71, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 3441.86, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 2605.98, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4056.48, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2581.39, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2581.39, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4056.48, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2458.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2458.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 2458.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3687.71, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "CATH VIANCE STANDARD CTO 150CM", "code_information": [ { "code": "C1887", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 115.24, "10th_percentile": 81.0, "90th_percentile": 503.66, "count": "23" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 156.51, "10th_percentile": 102.6, "90th_percentile": 572.45, "count": "11" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 129.36, "10th_percentile": 24.35, "90th_percentile": 512.12, "count": "1 through 10" } ] } ] }, { "description": "Cholecystectomy w/cholang", "code_information": [ { "code": "47605", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 12372.5, "discounted_cash": 2350.0, "minimum": 834.16, "maximum": 9898.0, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 1562.58 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 834.16 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 1738.81 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 1738.81 } ] } ] }, { "description": "MESH PERFIX PLUG XLARGE", "code_information": [ { "code": "C1781", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1862.28, "10th_percentile": 1862.28, "90th_percentile": 11852.02, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1206.78, "10th_percentile": 1206.78, "90th_percentile": 1206.78, "count": "1 through 10" } ] } ] }, { "description": "METHADONE QL SQN", "code_information": [ { "code": "80299", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 20.0, "discounted_cash": 34.0, "minimum": 3.0, "maximum": 340.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.27, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.0 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 20.0 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 16.22 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.0 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 20.0 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 20.0 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 20.0, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 20.0, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 19.76, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 87.74, "10th_percentile": 52.01, "90th_percentile": 104.02, "count": "1 through 10" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 20.0, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 19.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.0 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.0 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 20.0 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.0 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.0 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.0, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 18.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.0 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 18.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 104.02, "10th_percentile": 104.02, "90th_percentile": 104.02, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 20.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 20.0, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "DSMT OUPTP EACH 30 MIN", "code_information": [ { "code": "G0108", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 162.29, "minimum": 24.3435, "maximum": 162.29, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 53.32, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 152.36 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 48.91 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 162.29 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 162.29 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 81.62, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 76.17, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 57.67, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 89.78, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 57.13, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 57.13, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 89.78, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 54.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 54.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 54.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 73.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 81.62, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "UNIVERSAL REVERSE SPACER 39+6M", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "HYDRATION IV INFUSION INIT (31 - 96360 - 006005", "code_information": [ { "code": "96360", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 583.2, "discounted_cash": 65.0, "minimum": 33.5472, "maximum": 798.872, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 84.76, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 104.5 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 33.55 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 116.07 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 116.07 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 129.74, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 121.09, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 91.68, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 189.73, "10th_percentile": 124.45, "90th_percentile": 998.59, "count": "13" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 142.71, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 90.81, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 90.81, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 142.71, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 86.49, "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": 19.0, "median_amount": 189.73, "10th_percentile": 179.75, "90th_percentile": 189.73, "count": "1 through 10" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 86.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 86.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 189.73, "10th_percentile": 179.75, "90th_percentile": 213.1, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 129.74, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "DOPPLER (ECHO LIMITED)", "code_information": [ { "code": "93321", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 654.5, "discounted_cash": 124.0, "minimum": 17.2434, "maximum": 580.0, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 53.71 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 17.24 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 59.66 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 59.66 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 24.6, "median_amount": 39.25, "10th_percentile": 39.25, "90th_percentile": 39.25, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 580.0 } ] } ] }, { "description": "Removal sutr/staple req anes", "code_information": [ { "code": "15851", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2651.25, "discounted_cash": 503.0, "minimum": 50.74, "maximum": 2121.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 822.27, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 68.6 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 50.74 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 76.46 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 76.46 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1258.58, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 1174.67, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 889.39, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1384.43, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 881.0, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 881.0, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1384.43, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 839.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 839.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 839.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1258.58, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "TRAUMATIC STUPOR AND COMA >1 HOUR WITH MCC", "code_information": [ { "code": "082", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 15491.1, "maximum": 33777.0, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 15491.1 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 21912.05 } ] } ] }, { "description": "ANTIPARIETAL CELL AB (APCA)LC", "code_information": [ { "code": "83516", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 40.75, "discounted_cash": 32.0, "minimum": 4.4625, "maximum": 436.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11.3, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.26 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 40.75 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 10.03 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.26 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 40.75 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 40.75 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 94.5, "10th_percentile": 94.5, "90th_percentile": 114.75, "count": "1 through 10" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17.3, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 16.14, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 12.22, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 30.38, "10th_percentile": 5.36, "90th_percentile": 96.03, "count": "1 through 10" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.02, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.24 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.76 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 20.53 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.26 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.47 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.02, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "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": "fee schedule", "standard_charge_dollar": 15.79 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 5.65, "10th_percentile": 5.65, "90th_percentile": 5.65, "count": "1 through 10" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 18.89 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.3, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "MAJOR O.R. PROCEDURES FOR LYMPHATICHEMATOPOIETICOTHER NEOPLASMS - SOI : 4", "code_information": [ { "code": "6804", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 153203.35, "maximum": 162395.55, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 159596.67 } ] } ] }, { "description": "OT WHIRLPOOL TX", "code_information": [ { "code": "97022", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 141.86, "discounted_cash": 26.0, "minimum": 14.8666, "maximum": 161.44, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14.87, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 49.81 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 15.99 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 55.32 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 55.32 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.76, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 21.24, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 16.08, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 25.03, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 15.93, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.93, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 25.03, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 15.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 15.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 15.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 79.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 22.76, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "Rpr aa hrn 1st 3-10 ncr/strn", "code_information": [ { "code": "49594", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8077.19, "discounted_cash": 1534.0, "minimum": 1211.5785, "maximum": 7713.98, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2409.3, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 6932.16 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 3700.63 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 7713.98 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 7713.98 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3687.71, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 3441.86, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 2605.98, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4056.48, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2581.39, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2581.39, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4056.48, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2458.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2458.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 2458.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3687.71, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "TENDON, MUSCLE & OTHER SOFT TISSUE PROCEDURES - SOI : 4", "code_information": [ { "code": "3174", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 39495.56, "maximum": 41865.29, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 41143.75 } ] } ] }, { "description": "GASTROINTESTINAL HEMORRHAGE WITH CC", "code_information": [ { "code": "378", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 4586.5976, "maximum": 21767.4, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 7479.17 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 9401.97 } ] } ] }, { "description": "MODERATELY EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS- SOI : 2", "code_information": [ { "code": "9512", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 16492.14, "maximum": 17481.66, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 17180.37 } ] } ] }, { "description": "COMP METABOLIC PANEL(ML)", "code_information": [ { "code": "80053", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 446.88, "discounted_cash": 84.0, "minimum": 9.1872, "maximum": 357.504, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 75.0, "median_amount": 335.16, "10th_percentile": 304.69, "90th_percentile": 335.16, "count": "28" }, { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.35, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.89 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 42.66 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 9.19 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.89 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 47.41 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 47.41 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 276.25, "10th_percentile": 250.25, "90th_percentile": 303.88, "count": "232" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.84, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Gray Count Insurance MGMT Systems", "plan_name": "Gray County Insurance MGMT Systems", "methodology": "percent of total billed charges", "standard_charge_percentage": 50.0, "median_amount": 18.51, "10th_percentile": 18.51, "90th_percentile": 18.51, "count": "1 through 10" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 11.19, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 550.89, "10th_percentile": 325.88, "90th_percentile": 852.24, "count": "15" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 84.91, "10th_percentile": 47.93, "90th_percentile": 245.81, "count": "982" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.42, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 11.09, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.79 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.85 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.09, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange EPO/HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 27.55, "median_amount": 18.51, "10th_percentile": 18.51, "90th_percentile": 18.51, "count": "1 through 10" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 18.8 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.89 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.67 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.42, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 10.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.46 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 84.91, "10th_percentile": 10.56, "90th_percentile": 84.91, "count": "688" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 10.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 10.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 84.91, "10th_percentile": 80.44, "90th_percentile": 95.36, "count": "262" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 17.29 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15.84, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "KIDNEY AND URETER PROCEDURES FOR NEOPLASM WITHOUT CCMCC", "code_information": [ { "code": "658", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 7292.2838, "maximum": 17587.9, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 17587.9 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 14877.11 } ] } ] }, { "description": "MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITHOUT CCMCC", "code_information": [ { "code": "437", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 4130.801, "maximum": 17263.8, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 6283.67 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 8180.59 } ] } ] }, { "description": "EX-FIX 11MM CRBN FBR RO 350MM", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "STENT RESOLUTE ONYX 2.25X18MM", "code_information": [ { "code": "C1874", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 4258.8, "10th_percentile": 4258.8, "90th_percentile": 4420.0, "count": "1 through 10" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1456.46, "10th_percentile": 975.0, "90th_percentile": 4680.0, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1444.95, "10th_percentile": 1444.95, "90th_percentile": 1444.95, "count": "1 through 10" } ] } ] }, { "description": "TIBIAL EMBASE FIXED CEMENT SZ", "code_information": [ { "code": "C1776", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 4588.1, "10th_percentile": 1617.12, "90th_percentile": 11630.3, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 9120.0, "10th_percentile": 9120.0, "90th_percentile": 9120.0, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 8640.0, "10th_percentile": 8640.0, "90th_percentile": 9120.0, "count": "1 through 10" } ] } ] }, { "description": "ELECTIVE HIP JOINT REPLACEMENT- SOI : 1", "code_information": [ { "code": "3241", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 18433.68, "maximum": 19539.7, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 19202.94 } ] } ] }, { "description": "HIP & FEMUR FRACTURE REPAIR - SOI : 1", "code_information": [ { "code": "3081", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 15626.89, "maximum": 16564.51, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 16279.02 } ] } ] }, { "description": "NON-EXTENSIVE OR PROCEDURES FOR OTHER COMPLICATIONS OF TREATMENT - SOI : 2", "code_information": [ { "code": "7942", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 13119.03, "maximum": 13906.17, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 13666.5 } ] } ] }, { "description": "SOLU-MEDROL - 63323025803", "drug_information": { "unit": 2.0, "type": "ML" }, "code_information": [ { "code": "63323025803", "type": "NDC" }, { "code": "J2919", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 75.0, "median_amount": 40.38, "10th_percentile": 36.48, "90th_percentile": 40.38, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 36.61, "10th_percentile": 27.24, "90th_percentile": 36.61, "count": "1 through 10" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 11.49, "10th_percentile": 9.69, "90th_percentile": 29.07, "count": "58" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 24.6, "median_amount": 7.95, "10th_percentile": 3.07, "90th_percentile": 8.83, "count": "27" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 10.23, "10th_percentile": 10.23, "90th_percentile": 18.48, "count": "26" } ] } ] }, { "description": "TX Closed-Elbow Dislocation w/", "code_information": [ { "code": "24600", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1063.75, "discounted_cash": 202.0, "minimum": 98.3038, "maximum": 851.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 98.3, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 286.8 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 153.1 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 319.15 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 319.15 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 150.47, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 140.43, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 106.33, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 165.51, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 105.33, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 105.33, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 165.51, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 100.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 100.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 100.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 150.47, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "PARATHYROID SCAN", "code_information": [ { "code": "78070", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1790.0, "discounted_cash": 340.0, "minimum": 159.3186, "maximum": 1432.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 159.32, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 504.43 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 1091.97 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 235.15 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 504.43 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1213.6 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 1213.6 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 243.86, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 227.6, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 172.32, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 381.99, "10th_percentile": 381.99, "90th_percentile": 381.99, "count": "1 through 10" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 268.24, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 170.7, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 534.7 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 706.01 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 170.7, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 636.66 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 504.43 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 666.05 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 268.24, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 162.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 489.74 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 162.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 162.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 344.33 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 243.86, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "HSV 2 SPEC AB IGG W/RFLX(REF)", "code_information": [ { "code": "86696", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 50.0, "discounted_cash": 9.0, "minimum": 7.5, "maximum": 138.448, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.96, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.31 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 50.0 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 16.83 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.31 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 50.0 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 50.0 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 28.0, "10th_percentile": 28.0, "90th_percentile": 34.0, "count": "1 through 10" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 29.03, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 27.09, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 20.51, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 9.5, "10th_percentile": 9.5, "90th_percentile": 9.5, "count": "1 through 10" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 31.93, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 20.32, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28.94 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 38.22 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.32, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 34.46 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.31 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 36.05 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 31.93, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 19.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26.51 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 19.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 19.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 31.68 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 29.03, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "TNKASE", "drug_information": { "unit": 50.0, "type": "ME" }, "code_information": [ { "code": "50242012047", "type": "NDC" }, { "code": "J3101", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 13363.28, "10th_percentile": 13363.28, "90th_percentile": 13363.28, "count": "1 through 10" } ] } ] }, { "description": "MONORAIL STENT 16MMX2.75", "code_information": [ { "code": "C1876", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 3100.8, "10th_percentile": 1880.29, "90th_percentile": 7522.24, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 3482.69, "10th_percentile": 3482.69, "90th_percentile": 3482.69, "count": "1 through 10" } ] } ] }, { "description": "SLP SPEECH TREATMENT 60MIN", "code_information": [ { "code": "92507", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 418.0, "discounted_cash": 79.0, "minimum": 45.6, "maximum": 334.4, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 75.0, "median_amount": 313.5, "10th_percentile": 313.5, "90th_percentile": 313.5, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 72.98, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 217.8 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 69.92 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 241.91 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 241.91 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 418.0, "10th_percentile": 418.0, "90th_percentile": 418.0, "count": "1 through 10" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 111.71, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 104.26, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 78.94, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 114.0, "10th_percentile": 114.0, "90th_percentile": 114.0, "count": "1 through 10" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 122.88, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 78.19, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 78.19, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 24.6, "median_amount": 111.01, "10th_percentile": 107.78, "90th_percentile": 137.96, "count": "15" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 122.88, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 74.47, "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": 19.0, "median_amount": 79.42, "10th_percentile": 79.42, "90th_percentile": 79.42, "count": "1 through 10" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 74.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 74.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 81.09, "10th_percentile": 75.24, "90th_percentile": 89.2, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 79.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 111.71, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "XR PELVIS 1/2 VIEWS", "code_information": [ { "code": "72170", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 618.81, "discounted_cash": 66.0, "minimum": 41.6598, "maximum": 503.24, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 75.0, "median_amount": 464.11, "10th_percentile": 464.11, "90th_percentile": 464.11, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 41.66, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 135.95 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 452.8 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 97.51 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 135.95 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 503.24 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 503.24 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 346.53, "10th_percentile": 346.53, "90th_percentile": 420.79, "count": "1 through 10" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 63.77, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 59.51, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 45.06, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 132.05, "10th_percentile": 117.57, "90th_percentile": 258.2, "count": "11" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 70.14, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 44.64, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 144.11 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 190.28 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 44.64, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "QTC Medical Group", "plan_name": "QTC Medical Group", "methodology": "fee schedule", "standard_charge_dollar": 97.59 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 171.59 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 135.95 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 179.51 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 70.14, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 42.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 131.99 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 117.57, "10th_percentile": 117.57, "90th_percentile": 117.57, "count": "1 through 10" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 42.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 42.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 117.57, "10th_percentile": 111.39, "90th_percentile": 132.05, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 68.82 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 63.77, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "Toxoplasma gondii Ab IgM", "code_information": [ { "code": "86778", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 36.65, "discounted_cash": 26.0, "minimum": 5.4975, "maximum": 113.6, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14.12, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.33 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 36.65 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.54 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.33 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 36.65 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 36.65 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 21.62, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 20.17, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 15.27, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 23.78, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 15.13, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.55 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28.46 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.13, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 25.66 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.33 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26.85 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 23.78, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 14.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.74 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 14.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 23.58 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.62, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "EBV NUCLEAR IGG AB QUAL(REF)", "code_information": [ { "code": "86664", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 84.1, "discounted_cash": 15.0, "minimum": 12.615, "maximum": 68.65, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 75.0, "median_amount": 63.08, "10th_percentile": 63.08, "90th_percentile": 63.08, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14.98, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.58 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 61.77 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 13.3 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.58 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 68.65 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 68.65 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.94, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 21.41, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 16.21, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 25.23, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 16.05, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.87 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.2 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.05, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 27.24 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.58 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28.49 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 25.23, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 15.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.95 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 15.98, "10th_percentile": 15.98, "90th_percentile": 15.98, "count": "1 through 10" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 15.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 15.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 25.04 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 22.94, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "ANA by IFA, Ref to Titer/Patte", "code_information": [ { "code": "86038", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 66.5, "discounted_cash": 12.0, "minimum": 1.8135, "maximum": 209.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.06 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 48.84 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 10.52 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.06 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 54.28 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 54.28 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 37.24, "10th_percentile": 37.24, "90th_percentile": 45.22, "count": "1 through 10" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.14, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 16.93, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 12.82, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 12.64, "10th_percentile": 3.01, "90th_percentile": 12.64, "count": "1 through 10" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.95, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.69, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.08 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.87 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.69, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 21.53 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.06 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.52 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.95, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "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": "fee schedule", "standard_charge_dollar": 16.56 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 12.64, "10th_percentile": 12.64, "90th_percentile": 12.64, "count": "1 through 10" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 19.79 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.14, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "BKV QN PCR", "code_information": [ { "code": "87799", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 412.5, "discounted_cash": 71.0, "minimum": 37.2708, "maximum": 576.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 41.98, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 60.45 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 173.07 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 37.27 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 60.45 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 192.35 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 192.35 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 64.26, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 59.98, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 45.41, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 70.69, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 44.98, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 64.08 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 84.61 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 44.98, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 76.3 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 60.45 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 79.82 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 70.69, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "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": "fee schedule", "standard_charge_dollar": 58.69 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 78.38, "10th_percentile": 78.38, "90th_percentile": 78.38, "count": "1 through 10" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 42.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 42.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 70.13 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 64.26, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "US AORTA", "code_information": [ { "code": "76770", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1200.27, "discounted_cash": 231.0, "minimum": 41.6598, "maximum": 973.504, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 41.66, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 135.95 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 452.8 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 97.51 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 135.95 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 503.24 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 503.24 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 741.98, "10th_percentile": 681.45, "90th_percentile": 827.48, "count": "1 through 10" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 63.77, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 59.51, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 45.06, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 365.06, "10th_percentile": 360.08, "90th_percentile": 365.06, "count": "1 through 10" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 259.68, "10th_percentile": 216.05, "90th_percentile": 1034.46, "count": "29" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 70.14, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 44.64, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 144.11 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 190.28 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 44.64, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 171.59 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 135.95 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 179.51 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 70.14, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 42.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 131.99 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 231.21, "10th_percentile": 228.05, "90th_percentile": 231.21, "count": "17" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 42.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 42.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 231.21, "10th_percentile": 216.05, "90th_percentile": 236.07, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 161.48 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 63.77, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "DORSAL & LUMBAR FUSION PROC FOR CURVATURE OF BACK - SOI : 2", "code_information": [ { "code": "3032", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 78169.81, "maximum": 82859.99, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 81431.91 } ] } ] }, { "description": "PIN MOTAGLENE SHOULDER", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "KIDNEY & URINARY TRACT PROCEDURES FOR NONMALIGNANCY - SOI : 1", "code_information": [ { "code": "4431", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 12687.36, "maximum": 13448.6, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 13216.82 } ] } ] }, { "description": "Toxoplasma gondii Ab IgG - 86777 - 800613", "code_information": [ { "code": "86777", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 26.45, "discounted_cash": 13.0, "minimum": 3.9675, "maximum": 64.61, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14.1, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.3 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 26.45 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.52 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.3 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 26.45 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 26.45 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 21.59, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 20.15, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 15.25, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 23.74, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 15.11, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.52 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26.45 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.11, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 25.62 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.3 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26.45 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 23.74, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 14.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.71 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 14.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 23.57 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.59, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "GASTROINTESTINAL OBSTRUCTION WITH CC", "code_information": [ { "code": "389", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 3795.0724, "maximum": 22518.0, "payers_information": [ { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "other", "standard_charge_dollar": 13500.0, "standard_charge_algorithm": "$4,500 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 18000.0, "10th_percentile": 18000.0, "90th_percentile": 18000.0, "count": "1 through 10" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 4938.51 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 7571.81 } ] } ] }, { "description": "Behavioral & qualitative anals", "code_information": [ { "code": "92524", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1031.25, "discounted_cash": 195.0, "minimum": 78.7002, "maximum": 825.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 105.05, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 245.15 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 78.7 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 272.28 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 272.28 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 160.79, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 150.07, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 113.62, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 176.86, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 112.55, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 112.55, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 176.86, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 107.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 107.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 107.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 79.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 160.79, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "OTHER ANEMIA & DISORDERS OF BLOOD & BLOOD-FORMING ORGANS - SOI : 1", "code_information": [ { "code": "6631", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 5753.96, "maximum": 6099.2, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 5994.08 } ] } ] }, { "description": "OTHER HEPATOBILIARY OR PANCREAS O.R. PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "425", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 7126.9594, "maximum": 19515.6, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 14672.7 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 14383.38 } ] } ] }, { "description": "URINARY STONES WITHOUT MCC", "code_information": [ { "code": "694", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 3367.9074, "maximum": 15762.6, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 4966.73 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 7494.16 } ] } ] }, { "description": "STENT XIENCE ALPINE 2.75X23MM", "code_information": [ { "code": "C1874", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 4258.8, "10th_percentile": 4258.8, "90th_percentile": 4420.0, "count": "1 through 10" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1456.46, "10th_percentile": 975.0, "90th_percentile": 4680.0, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1444.95, "10th_percentile": 1444.95, "90th_percentile": 1444.95, "count": "1 through 10" } ] } ] }, { "description": "STENT ONYX FRONTIER 2.5X34MM", "code_information": [ { "code": "C1874", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 4258.8, "10th_percentile": 4258.8, "90th_percentile": 4420.0, "count": "1 through 10" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1456.46, "10th_percentile": 975.0, "90th_percentile": 4680.0, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1444.95, "10th_percentile": 1444.95, "90th_percentile": 1444.95, "count": "1 through 10" } ] } ] }, { "description": "NON-EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS- SOI : 4", "code_information": [ { "code": "9524", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 99398.81, "maximum": 105362.74, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 103546.82 } ] } ] }, { "description": "OTHER DIGESTIVE SYSTEM & ABDOMINAL PROCEDURES - SOI : 3", "code_information": [ { "code": "2293", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 36647.71, "maximum": 38846.57, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 38177.05 } ] } ] }, { "description": "CATH 5F LCB 100CM", "code_information": [ { "code": "C1887", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 115.24, "10th_percentile": 81.0, "90th_percentile": 503.66, "count": "23" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 156.51, "10th_percentile": 102.6, "90th_percentile": 572.45, "count": "11" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 129.36, "10th_percentile": 24.35, "90th_percentile": 512.12, "count": "1 through 10" } ] } ] }, { "description": "CATH QUANTUM 20MM X 3.0M", "code_information": [ { "code": "C1725", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 462.76, "10th_percentile": 256.45, "90th_percentile": 2515.23, "count": "21" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 270.69, "10th_percentile": 106.59, "90th_percentile": 1342.29, "count": "14" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 484.0, "10th_percentile": 143.56, "90th_percentile": 543.74, "count": "1 through 10" } ] } ] }, { "description": "STENT BILLARY 6FR 80X5MM", "code_information": [ { "code": "C1876", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 3100.8, "10th_percentile": 1880.29, "90th_percentile": 7522.24, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 3482.69, "10th_percentile": 3482.69, "90th_percentile": 3482.69, "count": "1 through 10" } ] } ] }, { "description": "Cystoscopy and treatment - 52310 - OR36052310", "code_information": [ { "code": "52310", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2651.25, "discounted_cash": 503.0, "minimum": 397.6875, "maximum": 2621.89, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 833.07, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 2356.16 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 1257.8 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 2621.89 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 2621.89 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1275.11, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 1190.1, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 901.07, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1402.62, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 892.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 892.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1402.62, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 850.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 850.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 850.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1275.11, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "Exc shoulder les sc 3 cm/>", "code_information": [ { "code": "23071", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4418.75, "discounted_cash": 839.0, "minimum": 658.1974, "maximum": 3535.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 658.2, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 1825.56 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 974.55 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 2031.45 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 2031.45 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1007.45, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 940.28, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 711.93, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1108.19, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 705.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 705.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1108.19, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 671.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 671.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 671.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1007.45, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "INJ FOR SACROILIAC JT ANESTH - 27096 - 004014", "code_information": [ { "code": "27096", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2205.67, "discounted_cash": 419.0, "minimum": 60.9, "maximum": 1764.536, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 114.07 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 60.9 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 126.94 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 126.94 } ] } ] }, { "description": "MAJOR SKIN DISORDERS WITHOUT MCC", "code_information": [ { "code": "596", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 4568.1256, "maximum": 25520.4, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 4710.19 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 10377.93 } ] } ] }, { "description": "XR BARIUM ENEMA", "code_information": [ { "code": "74270", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1188.75, "discounted_cash": 225.0, "minimum": 69.8936, "maximum": 951.0, "payers_information": [ { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 71.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 220.58 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 71.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 71.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 181.48 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 106.98, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 69.89, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 227.2 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 736.17 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 158.53 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 227.2 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 818.17 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 818.17 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 106.98, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 99.85, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 75.6, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 117.68, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 74.89, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 240.83 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 317.99 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 74.89, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 286.75 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 227.2 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 299.99 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 117.68, "additional_payer_notes": "165.00% of Medicare Rates" } ] } ] }, { "description": "SCREW LOCKING T10 2.7X18MM", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "SURGIMESH 5X10CM CIRCLE", "code_information": [ { "code": "C1781", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1862.28, "10th_percentile": 1862.28, "90th_percentile": 11852.02, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1206.78, "10th_percentile": 1206.78, "90th_percentile": 1206.78, "count": "1 through 10" } ] } ] }, { "description": "FIBERTAG TIGHTROPE II ROUND 17", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITH MCC", "code_information": [ { "code": "871", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 8627.3476, "maximum": 36779.4, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 14003.1 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 18622.75 } ] } ] }, { "description": "CORT SCREW 2323-26", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "G0283 ESTIM UNATT NON-WOUND - G0283 - 690006", "code_information": [ { "code": "G0283", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 119.0, "minimum": 12.0932, "maximum": 127.6, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 39.08 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.55 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 43.4 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 43.4 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.51, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 17.28, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 13.08, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 20.36, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.96, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.96, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.36, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 12.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 79.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.51, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "XR SHOULDER 1 V-LT", "code_information": [ { "code": "73020", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 485.38, "discounted_cash": 92.0, "minimum": 34.6822, "maximum": 388.304, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 34.68, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 112.36 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 322.43 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 69.43 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 112.36 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 358.35 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 358.35 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 330.06, "10th_percentile": 330.06, "90th_percentile": 330.06, "count": "1 through 10" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 53.09, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 49.55, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 37.51, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 58.39, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 37.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 119.1 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 157.26 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 37.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "QTC Medical Group", "plan_name": "QTC Medical Group", "methodology": "fee schedule", "standard_charge_dollar": 51.82 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 141.82 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 112.36 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 148.36 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 58.39, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 35.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 109.09 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 92.22, "10th_percentile": 92.22, "90th_percentile": 92.22, "count": "1 through 10" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 35.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 35.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 68.82 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 53.09, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "OTHER PROCEDURES FOR ENDOCRINE, NUTRITIONAL & METABOLIC DISORDERS - SOI : 2", "code_information": [ { "code": "4052", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 28242.63, "maximum": 29937.19, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 29421.22 } ] } ] }, { "description": "VITAMIN D3 25-OH", "code_information": [ { "code": "82306", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 300.38, "discounted_cash": 57.0, "minimum": 21.0, "maximum": 240.304, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 75.0, "median_amount": 111.0, "10th_percentile": 111.0, "90th_percentile": 122.1, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 29.01, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 41.78 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 119.58 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 25.75 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 41.78 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 132.9 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 132.9 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 110.7, "10th_percentile": 91.17, "90th_percentile": 110.7, "count": "47" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 44.4, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 41.44, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 31.38, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 231.58, "10th_percentile": 231.58, "90th_percentile": 231.58, "count": "1 through 10" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 30.93, "10th_percentile": 29.3, "90th_percentile": 34.74, "count": "61" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 48.84, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 31.08, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 44.28 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 58.47 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 31.08, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 52.73 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 41.78 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 55.16 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 48.84, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "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": "fee schedule", "standard_charge_dollar": 40.56 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 30.93, "10th_percentile": 29.6, "90th_percentile": 30.93, "count": "51" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 29.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 29.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 30.93, "10th_percentile": 29.3, "90th_percentile": 34.74, "count": "16" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 48.48 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 44.4, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "MAJOR HEMATOLOGICIMMUNOLOGIC DIAG EXC SICKLE CELL CRISIS & COAGUL - SOI : 3", "code_information": [ { "code": "6603", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 20236.75, "maximum": 21450.95, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 21081.25 } ] } ] }, { "description": "UNI G2 MEDIAL KNEE", "code_information": [ { "code": "C1776", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 4588.1, "10th_percentile": 1617.12, "90th_percentile": 11630.3, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 9120.0, "10th_percentile": 9120.0, "90th_percentile": 9120.0, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 8640.0, "10th_percentile": 8640.0, "90th_percentile": 9120.0, "count": "1 through 10" } ] } ] }, { "description": "FLUROGUIDE FOR VEIN DEVICE", "code_information": [ { "code": "77001", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1041.73, "discounted_cash": 197.0, "minimum": 63.336, "maximum": 833.384, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 294.11 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 63.34 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 326.87 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 326.87 } ] } ] }, { "description": "CATH GUIDE ADROIT 6FR XB3", "code_information": [ { "code": "C1887", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 115.24, "10th_percentile": 81.0, "90th_percentile": 503.66, "count": "23" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 156.51, "10th_percentile": 102.6, "90th_percentile": 572.45, "count": "11" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 129.36, "10th_percentile": 24.35, "90th_percentile": 512.12, "count": "1 through 10" } ] } ] }, { "description": "ESOPH EGD DILATION <30 MM - 43249 - 007212", "code_information": [ { "code": "43249", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3562.5, "discounted_cash": 676.0, "minimum": 331.407, "maximum": 2850.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 764.73, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 2071.34 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 1105.75 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 2304.95 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 2304.95 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1170.51, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 1092.48, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 827.16, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1287.56, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 819.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 819.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1287.56, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 780.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 780.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 780.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1170.51, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "CT L-SPINE W/ CONTRAST", "code_information": [ { "code": "72132", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3886.91, "discounted_cash": 738.0, "minimum": 139.0326, "maximum": 3109.528, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 139.03, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 475.54 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 1542.67 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 332.21 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 475.54 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1714.51 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 1714.51 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 212.81, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 198.62, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 150.38, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 234.09, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 148.96, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 504.07 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 665.57 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 148.96, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 600.2 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 475.54 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 627.9 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 234.09, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 141.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 461.69 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 738.51, "10th_percentile": 738.51, "90th_percentile": 738.51, "count": "1 through 10" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 141.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 141.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 298.8 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 212.81, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "DORSAL & LUMBAR FUSION PROC EXCEPT FOR CURVATURE OF BACK - SOI : 2", "code_information": [ { "code": "3042", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 40707.47, "maximum": 43149.92, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 42406.23 } ] } ] }, { "description": "Treatment of tibia fracture", "code_information": [ { "code": "27758", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 9721.25, "discounted_cash": 1847.0, "minimum": 1458.1875, "maximum": 9721.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5116.57, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 9721.25 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 8449.5 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 9721.25 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 9721.25 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7831.49, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 7309.39, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 5534.25, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8614.63, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5482.04, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5482.04, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8614.63, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5220.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5220.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 5220.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7831.49, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "PH STOOL LC", "code_information": [ { "code": "83986", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 12.95, "discounted_cash": 2.0, "minimum": 1.9425, "maximum": 61.6, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3.51, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.06 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 12.95 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3.11 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.06 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 12.95 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 12.95 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5.37, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 5.01, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 3.79, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5.91, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3.76, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.36 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.08 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.76, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 6.38 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.06 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.68 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.91, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.91 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 3.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 5.86 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5.37, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "HUMERAL STEM AEQUALIS FLEX", "code_information": [ { "code": "C1776", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 4588.1, "10th_percentile": 1617.12, "90th_percentile": 11630.3, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 9120.0, "10th_percentile": 9120.0, "90th_percentile": 9120.0, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 8640.0, "10th_percentile": 8640.0, "90th_percentile": 9120.0, "count": "1 through 10" } ] } ] }, { "description": "SCREW VARIABLE ANGLE LCKNG5X35", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "CHOLECYSTECTOMY- SOI : 3", "code_information": [ { "code": "2633", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 19088.82, "maximum": 20234.15, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 19885.41 } ] } ] }, { "description": "SELF DRILLING PIN 4.0/3", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "COLONOSCOPY W/ BX THRU STOMA - G0121 - 007165", "code_information": [ { "code": "G0121", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2993.5, "minimum": 370.6164, "maximum": 3143.92, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 370.62, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 1015.96 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 542.35 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 1130.54 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 1130.54 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 567.27, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 529.45, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 400.87, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 624.0, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 397.09, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 397.09, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 624.0, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 378.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 378.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 378.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 567.27, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "PLATE HOOK LCP 3.5MM 3 HOLE", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "INS CATH ABD/L-EXT ART 1ST", "code_information": [ { "code": "36245", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6134.85, "discounted_cash": 1165.0, "minimum": 668.9415, "maximum": 4907.88, "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 847.33, "10th_percentile": 847.33, "90th_percentile": 1309.18, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 847.33, "10th_percentile": 847.33, "90th_percentile": 847.33, "count": "1 through 10" } ] } ] }, { "description": "Change of bladder tube - 51705 - OR36051705", "code_information": [ { "code": "51705", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1174.5, "discounted_cash": 223.0, "minimum": 43.56, "maximum": 1470.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 99.57, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 58.9 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 43.56 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 65.64 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 65.64 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 152.4, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 142.24, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 107.7, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 167.64, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 106.68, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 106.68, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 167.64, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 101.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 101.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 101.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 152.4, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "SCREW CANNULATED 4.0X30MM 207.", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "CATH TRAILBLAZER 4 FR ANG .014", "code_information": [ { "code": "C1887", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 115.24, "10th_percentile": 81.0, "90th_percentile": 503.66, "count": "23" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 156.51, "10th_percentile": 102.6, "90th_percentile": 572.45, "count": "11" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 129.36, "10th_percentile": 24.35, "90th_percentile": 512.12, "count": "1 through 10" } ] } ] }, { "description": "CATH QUANTUM 9MM X 3.5MM", "code_information": [ { "code": "C1725", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 462.76, "10th_percentile": 256.45, "90th_percentile": 2515.23, "count": "21" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 270.69, "10th_percentile": 106.59, "90th_percentile": 1342.29, "count": "14" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 484.0, "10th_percentile": 143.56, "90th_percentile": 543.74, "count": "1 through 10" } ] } ] }, { "description": "IV INFUSION CASIRIVI/IMDEVI", "code_information": [ { "code": "M0243", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1548.0, "minimum": 32.0, "maximum": 1238.4, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 175.73, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 450.0 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 450.0 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 450.0 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 450.0 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 268.98, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 251.05, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 190.08, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 295.88, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 188.29, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 188.29, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 295.88, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 179.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 179.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 179.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 32.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 268.98, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "Amputation of finger/thumb - 26951 - OR36026951", "code_information": [ { "code": "26951", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3030.0, "discounted_cash": 1382.0, "minimum": 454.5, "maximum": 5821.04, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1303.98, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 3030.0 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 1943.59 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 3030.0 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 3030.0 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1995.89, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 1862.83, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 1410.43, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2195.47, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1397.12, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1397.12, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2195.47, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1330.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1330.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 1330.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1995.89, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "PACEMAKER SEPHYR XL SR", "code_information": [ { "code": "C1786", "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": 19.0, "median_amount": 4220.28, "10th_percentile": 4220.28, "90th_percentile": 4220.28, "count": "1 through 10" } ] } ] }, { "description": "SCRW VARIABLE LKNG 3.5X80MM", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "TOMO MAMMO DIAGNOSTIC--UNILAT", "code_information": [ { "code": "77061", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 199.5, "discounted_cash": 37.0, "minimum": 29.925, "maximum": 199.5, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 199.5 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 81.83 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 199.5 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 199.5 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 144.35 } ] } ] }, { "description": "MRA ABD W/O CONTRAST", "code_information": [ { "code": "74185", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3654.64, "discounted_cash": 729.0, "minimum": 269.3346, "maximum": 3072.44, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 1250.7 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 269.33 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1390.01 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 1390.01 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 401.08 } ] } ] }, { "description": "CLTX TIBIAL SHAFT FX W/MAN", "code_information": [ { "code": "27752", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6566.7, "discounted_cash": 1247.0, "minimum": 640.822, "maximum": 5253.36, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 640.82, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 1802.67 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 962.33 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 2005.98 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 2005.98 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 980.85, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 915.46, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 693.13, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1078.94, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 686.6, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 686.6, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1078.94, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 653.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 653.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 653.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 980.85, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "CATH POLAR 5X60X120", "code_information": [ { "code": "C1725", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 462.76, "10th_percentile": 256.45, "90th_percentile": 2515.23, "count": "21" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 270.69, "10th_percentile": 106.59, "90th_percentile": 1342.29, "count": "14" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 484.0, "10th_percentile": 143.56, "90th_percentile": 543.74, "count": "1 through 10" } ] } ] }, { "description": "TOXIC EFFECTS OF NON-MEDICINAL SUBSTANCES - SOI : 3", "code_information": [ { "code": "8163", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 16930.49, "maximum": 17946.32, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 17637.01 } ] } ] }, { "description": "SEPTIC ARTHRITIS WITH MCC", "code_information": [ { "code": "548", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 9372.6928, "maximum": 47287.8, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 19122.9 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 18511.54 } ] } ] }, { "description": "THER/PROPH/DIAG IV INF INIT(LN", "code_information": [ { "code": "96365", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 642.25, "discounted_cash": 52.0, "minimum": 41.1, "maximum": 998.59, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 84.76, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 197.29 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 63.34 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 219.13 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 219.13 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 129.74, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 121.09, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 91.68, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 189.73, "10th_percentile": 137.06, "90th_percentile": 998.59, "count": "153" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 142.71, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 90.81, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 90.81, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 142.71, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 86.49, "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": 19.0, "median_amount": 189.73, "10th_percentile": 189.73, "90th_percentile": 189.73, "count": "45" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 86.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 86.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 189.73, "10th_percentile": 137.06, "90th_percentile": 213.1, "count": "33" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 642.25 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 129.74, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "CULTURE EYE", "code_information": [ { "code": "87070", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 204.71, "discounted_cash": 42.0, "minimum": 7.4994, "maximum": 180.144, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 75.0, "median_amount": 168.89, "10th_percentile": 153.53, "90th_percentile": 168.89, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.45, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.16 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 34.82 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 7.5 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.16 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 38.7 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 38.7 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 139.2, "10th_percentile": 126.1, "90th_percentile": 153.12, "count": "37" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12.93, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 12.07, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 9.14, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 243.32, "10th_percentile": 67.55, "90th_percentile": 575.54, "count": "1 through 10" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 42.78, "10th_percentile": 8.62, "90th_percentile": 48.05, "count": "52" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.22, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 9.05, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.89 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.03 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.05, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 15.35 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.16 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.06 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.22, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "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": "fee schedule", "standard_charge_dollar": 11.81 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 42.78, "10th_percentile": 8.62, "90th_percentile": 42.78, "count": "46" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 8.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 42.78, "10th_percentile": 25.35, "90th_percentile": 50.7, "count": "13" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 14.1 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.93, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "PT WOUND DEBRID NONSEL", "code_information": [ { "code": "97602", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1035.93, "discounted_cash": 50.0, "minimum": 39.7005, "maximum": 828.744, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 79.96, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 473.52 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 152.02 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 525.94 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 525.94 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 122.39, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 114.23, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 86.49, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 932.34, "10th_percentile": 621.56, "90th_percentile": 3418.57, "count": "1 through 10" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 221.07, "10th_percentile": 108.49, "90th_percentile": 1035.93, "count": "109" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 134.62, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 85.67, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 24.6, "median_amount": 219.62, "10th_percentile": 219.62, "90th_percentile": 226.2, "count": "1 through 10" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.67, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 24.6, "median_amount": 35.43, "10th_percentile": 35.43, "90th_percentile": 75.29, "count": "1 through 10" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 134.62, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 81.59, "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": 19.0, "median_amount": 196.83, "10th_percentile": 196.83, "90th_percentile": 196.83, "count": "23" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 81.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 81.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 186.47, "10th_percentile": 108.49, "90th_percentile": 221.07, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 79.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 122.39, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "SCREW CORTEX 2.7MM X 26MM ST", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "PROCAINAMIDE/PRONESTYL (ML)", "code_information": [ { "code": "80192", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 184.0, "discounted_cash": 34.0, "minimum": 14.5725, "maximum": 147.2, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 16.42, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.64 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 67.67 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 14.57 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.64 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 75.21 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 75.21 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 25.13, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 23.45, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 17.76, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 27.64, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 17.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.06 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 33.08 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 29.84 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.64 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.21 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 27.64, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 16.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.95 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 16.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 27.42 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 25.13, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "BILE ACIDS TOT", "code_information": [ { "code": "82239", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 137.5, "discounted_cash": 26.0, "minimum": 14.8944, "maximum": 110.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 16.78, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.15 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 69.16 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 14.89 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.15 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 76.87 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 76.87 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 25.68, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 23.97, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 18.15, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 28.25, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 17.98, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.6 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 33.81 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.98, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 30.49 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.15 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.89 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 28.25, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 17.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.45 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 17.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 17.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 28.04 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 25.68, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "HEMOGLOBIN - 85018 - 850508", "code_information": [ { "code": "85018", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 63.25, "discounted_cash": 1.0, "minimum": 1.0, "maximum": 50.6, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2.32, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.35 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 9.57 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2.06 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.35 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 10.64 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 10.64 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3.56, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 3.32, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 2.51, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 12.27, "10th_percentile": 9.49, "90th_percentile": 13.5, "count": "1 through 10" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3.91, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2.49, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.55 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.69 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.49, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 4.23 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.35 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.42 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3.91, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "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": "fee schedule", "standard_charge_dollar": 3.25 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 12.02, "10th_percentile": 12.02, "90th_percentile": 12.02, "count": "1 through 10" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 2.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 3.88 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3.56, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "CARBON MONOXIDE QN(REF)", "code_information": [ { "code": "82375", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 289.0, "discounted_cash": 37.0, "minimum": 10.7184, "maximum": 231.2, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12.07, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.39 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 49.77 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 10.72 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.39 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 55.32 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 55.32 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.48, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 17.25, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 13.06, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 20.33, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.94, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.43 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.33 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.94, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 21.94 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.39 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.96 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.33, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.88 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 12.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 20.17 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.48, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "TRAUMA ACTIVATION", "code_information": [ { "code": "G0390", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8250.0, "minimum": 775.3005, "maximum": 6600.0, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 2415.02 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 775.3 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2682.36 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 2682.36 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1567.5, "10th_percentile": 1567.5, "90th_percentile": 1567.5, "count": "1 through 10" } ] } ] }, { "description": "STENT VISI-PRO EV3 8X37MM", "code_information": [ { "code": "C1874", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 4258.8, "10th_percentile": 4258.8, "90th_percentile": 4420.0, "count": "1 through 10" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1456.46, "10th_percentile": 975.0, "90th_percentile": 4680.0, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1444.95, "10th_percentile": 1444.95, "90th_percentile": 1444.95, "count": "1 through 10" } ] } ] }, { "description": "SAFESHEATH INTRODUCER 13CM 6FR", "code_information": [ { "code": "C1894", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 112.23, "10th_percentile": 28.87, "90th_percentile": 279.68, "count": "37" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 99.92, "10th_percentile": 25.71, "90th_percentile": 152.65, "count": "26" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 94.66, "10th_percentile": 56.02, "90th_percentile": 112.23, "count": "11" } ] } ] }, { "description": "MESH SURG ULTRAPRO ADV 30X30CM", "code_information": [ { "code": "C1781", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1862.28, "10th_percentile": 1862.28, "90th_percentile": 11852.02, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1206.78, "10th_percentile": 1206.78, "90th_percentile": 1206.78, "count": "1 through 10" } ] } ] }, { "description": "DX MAMMO INCL CAD BI", "code_information": [ { "code": "77066", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 120.23, "discounted_cash": 85.0, "minimum": 18.0345, "maximum": 451.93, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 102.79, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 120.23 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 104.72 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 120.23 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 120.23 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 120.23, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 120.23, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 111.18, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 120.23, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 110.13, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 110.13, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 120.23, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 104.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 104.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 104.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 120.23 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 120.23, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "HUMERAL NAIL CANNULATED 7X200M", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "EXT DNA EXTRACTION OBI - 81479 - 800522", "code_information": [ { "code": "81479", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 28.5, "discounted_cash": 5.0, "minimum": 4.275, "maximum": 28.5, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 28.5 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 22.32 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 28.5 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 28.5 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 28.5 } ] } ] }, { "description": "IA-2 AUTOANTIBODIES", "code_information": [ { "code": "86341", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 252.5, "discounted_cash": 52.0, "minimum": 20.5059, "maximum": 328.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 23.1, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 33.26 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 95.22 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 20.51 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 33.26 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 105.83 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 105.83 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 35.36, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 33.0, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 24.98, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 38.89, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 24.75, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 35.25 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 46.55 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.75, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 41.98 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 33.26 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 43.91 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 38.89, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "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": "fee schedule", "standard_charge_dollar": 32.29 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 23.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 23.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 32.39 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 35.36, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "Punch bx skin single lesion", "code_information": [ { "code": "11104", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 883.75, "discounted_cash": 167.0, "minimum": 62.69, "maximum": 707.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 162.0, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 84.76 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 62.69 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 94.47 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 94.47 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 247.97, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 231.43, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 175.23, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 272.76, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 173.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 272.76, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 165.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 165.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 165.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 247.97, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "POLAR CATH 4.0MX60MX135C", "code_information": [ { "code": "C1725", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 462.76, "10th_percentile": 256.45, "90th_percentile": 2515.23, "count": "21" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 270.69, "10th_percentile": 106.59, "90th_percentile": 1342.29, "count": "14" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 484.0, "10th_percentile": 143.56, "90th_percentile": 543.74, "count": "1 through 10" } ] } ] }, { "description": "REFOBACIN BONE CEMENT R 1X40 U", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "PERIPROSTHETIC SCREW 5.0X12", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "AMPUTATION FINGER OR THUMB", "code_information": [ { "code": "26951", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7276.3, "discounted_cash": 1382.0, "minimum": 454.5, "maximum": 5821.04, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1303.98, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 3640.81 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 1943.59 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 4051.43 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 4051.43 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1995.89, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 1862.83, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 1410.43, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2195.47, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1397.12, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1397.12, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2195.47, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1330.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1330.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 1330.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1995.89, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "Treat lower leg fracture - 27827 - OR36027827", "code_information": [ { "code": "27827", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 12372.5, "discounted_cash": 2350.0, "minimum": 1855.875, "maximum": 12372.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5116.57, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 12372.5 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 8449.5 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 12372.5 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 12372.5 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7831.49, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 7309.39, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 5534.25, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8614.63, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5482.04, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5482.04, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8614.63, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5220.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5220.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 5220.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7831.49, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "URINALYSIS AUTO W/O SCOPE", "code_information": [ { "code": "81003", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 12.38, "discounted_cash": 2.0, "minimum": 1.857, "maximum": 10.1, "payers_information": [ { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 3.67 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3.38, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 75.0, "median_amount": 8.44, "10th_percentile": 8.44, "90th_percentile": 9.29, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2.21, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.17 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 9.09 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1.96 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.17 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 10.1 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 10.1 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 7.65, "10th_percentile": 6.93, "90th_percentile": 8.42, "count": "34" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3.38, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 3.15, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 2.39, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 368.78, "10th_percentile": 368.78, "90th_percentile": 368.78, "count": "1 through 10" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 2.35, "10th_percentile": 2.23, "90th_percentile": 2.64, "count": "80" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3.71, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.36 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.44 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange EPO/HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 27.55, "median_amount": 3.94, "10th_percentile": 3.94, "90th_percentile": 3.94, "count": "1 through 10" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 4.0 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.17 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.19 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3.71, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "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": "fee schedule", "standard_charge_dollar": 3.08 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 2.35, "10th_percentile": 2.35, "90th_percentile": 2.35, "count": "57" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 2.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 2.64, "10th_percentile": 2.23, "90th_percentile": 2.64, "count": "29" } ] } ] }, { "description": "CYTO PAP C/V DEF HORM EVAL LC", "code_information": [ { "code": "88155", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 115.15, "discounted_cash": 14.0, "minimum": 9.82, "maximum": 92.12, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14.36, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.67 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 59.19 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.75 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.67 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 65.78 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 65.78 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 21.98, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 20.51, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 15.53, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 24.17, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 15.38, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.91 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28.93 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.38, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 26.09 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.67 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.3 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 24.17, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 14.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.07 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 14.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 9.82 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.98, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "ZOSYN 3.375 GM", "drug_information": { "unit": 3.375, "type": "GR" }, "code_information": [ { "code": "00409338513", "type": "NDC" }, { "code": "J2543", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 56.03, "10th_percentile": 46.14, "90th_percentile": 217.6, "count": "1 through 10" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 15.66, "10th_percentile": 14.83, "90th_percentile": 59.33, "count": "37" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 24.6, "median_amount": 4.65, "10th_percentile": 4.53, "90th_percentile": 18.12, "count": "1 through 10" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 24.6, "median_amount": 4.65, "10th_percentile": 4.65, "90th_percentile": 4.65, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 15.66, "10th_percentile": 15.66, "90th_percentile": 15.66, "count": "19" } ] } ] }, { "description": "CATHETER 100CM 7FR XBLAD 3.5", "code_information": [ { "code": "C1887", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 115.24, "10th_percentile": 81.0, "90th_percentile": 503.66, "count": "23" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 156.51, "10th_percentile": 102.6, "90th_percentile": 572.45, "count": "11" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 129.36, "10th_percentile": 24.35, "90th_percentile": 512.12, "count": "1 through 10" } ] } ] }, { "description": "Unilateral Extremity Venogram - 75820 - 758200", "code_information": [ { "code": "75820", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4070.25, "discounted_cash": 773.0, "minimum": 548.5437, "maximum": 4070.248, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 627.35, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1980.35 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 2547.26 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 548.54 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1980.35 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2830.99 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 2830.99 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 960.23, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 896.21, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 678.56, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1056.25, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 672.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2099.17 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2771.72 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 672.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 2499.47 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1980.35 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2614.83 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1056.25, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 640.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1922.67 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 640.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 640.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 868.59, "10th_percentile": 868.59, "90th_percentile": 868.59, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 992.34 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 960.23, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "Cystouretero w/biopsy", "code_information": [ { "code": "52354", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1767.5, "discounted_cash": 335.0, "minimum": 265.125, "maximum": 1767.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1767.5, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 1767.5 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 1767.5 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 1767.5 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 1767.5 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1767.5, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 1767.5, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 1767.5, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1767.5, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1767.5, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1767.5, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1767.5, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1767.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1767.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 1767.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1767.5, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "CONCUSSION, CLOSED SKULL FX NOS,UNCOMPLICATED INTRACRANIAL INJURY, COMA < 1 HR OR NO COMA - SOI : 1", "code_information": [ { "code": "0571", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 5533.35, "maximum": 5865.35, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 5764.26 } ] } ] }, { "description": "CANC SCREW 2333-55", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "GUIDE CATH 6FR XB4 .072 100MM", "code_information": [ { "code": "C1887", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 115.24, "10th_percentile": 81.0, "90th_percentile": 503.66, "count": "23" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 156.51, "10th_percentile": 102.6, "90th_percentile": 572.45, "count": "11" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 129.36, "10th_percentile": 24.35, "90th_percentile": 512.12, "count": "1 through 10" } ] } ] }, { "description": "ANGIOSCULPT RX PTCA TAPER 2.5X - C1725 - 900262", "code_information": [ { "code": "C1725", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 462.76, "10th_percentile": 256.45, "90th_percentile": 2515.23, "count": "21" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 270.69, "10th_percentile": 106.59, "90th_percentile": 1342.29, "count": "14" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 484.0, "10th_percentile": 143.56, "90th_percentile": 543.74, "count": "1 through 10" } ] } ] }, { "description": "CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITHOUT CCMCC", "code_information": [ { "code": "310", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 2578.6912, "maximum": 13510.8, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 3856.74 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 5427.2 } ] } ] }, { "description": "2.4MM VA-LCP DSTLRADIUS", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "DUP VEIN UNI/LTD-RT - 93971 - 742986", "code_information": [ { "code": "93971", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 915.0, "discounted_cash": 239.0, "minimum": 41.6598, "maximum": 1006.504, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 41.66, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 138.01 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 271.51 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 87.17 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 138.01 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 301.57 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 301.57 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 855.53, "10th_percentile": 704.55, "90th_percentile": 855.53, "count": "1 through 10" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 63.77, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 59.51, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 45.06, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 343.13, "10th_percentile": 343.13, "90th_percentile": 377.44, "count": "1 through 10" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 244.08, "10th_percentile": 226.46, "90th_percentile": 268.48, "count": "27" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 70.14, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 44.64, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 146.29 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 193.16 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 44.64, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 174.19 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 138.01 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 182.23 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 70.14, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 42.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 133.99 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 239.04, "10th_percentile": 239.04, "90th_percentile": 239.04, "count": "28" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 42.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 42.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 239.04, "10th_percentile": 226.46, "90th_percentile": 268.48, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 781.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 63.77, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "STENT XIENCE ALPINE 2.5X15MM", "code_information": [ { "code": "C1874", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 4258.8, "10th_percentile": 4258.8, "90th_percentile": 4420.0, "count": "1 through 10" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1456.46, "10th_percentile": 975.0, "90th_percentile": 4680.0, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1444.95, "10th_percentile": 1444.95, "90th_percentile": 1444.95, "count": "1 through 10" } ] } ] }, { "description": "CERVICAL SPINAL FUSION WITH CC", "code_information": [ { "code": "472", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 11250.0, "maximum": 28303.164, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 23580.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 28244.26 } ] } ] }, { "description": "MAVERICK CATH 2.5X12MM", "code_information": [ { "code": "C1725", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 462.76, "10th_percentile": 256.45, "90th_percentile": 2515.23, "count": "21" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 270.69, "10th_percentile": 106.59, "90th_percentile": 1342.29, "count": "14" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 484.0, "10th_percentile": 143.56, "90th_percentile": 543.74, "count": "1 through 10" } ] } ] }, { "description": "XR SURGICAL SPECIMEN - 76098 - 760027", "code_information": [ { "code": "76098", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1830.65, "discounted_cash": 347.0, "minimum": 217.7658, "maximum": 1830.65, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 217.77, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 682.16 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 1830.65 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 418.97 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 682.16 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1830.65 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 1830.65 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 333.32, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 311.09, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 235.54, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 366.65, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 233.32, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 723.09 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 954.76 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 233.32, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 860.98 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 682.16 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 900.71 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 366.65, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 222.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 662.29 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 222.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 222.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 381.49 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 333.32, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "AMI BMS PCI INCL ASPIRATION", "code_information": [ { "code": "92941", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 25022.5, "discounted_cash": 4754.0, "minimum": 496.148, "maximum": 20018.0, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 1153.02 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 496.15 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 1278.8 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 1278.8 } ] } ] }, { "description": "ULTRASOUND ACCELERATED AND OTHER THROMBOLYSIS OF PERIPHERAL VASCULAR STRUCTURES WITHOUT MCC", "code_information": [ { "code": "279", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 13950.0, "maximum": 34574.5568, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 26387.5 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 34574.56 } ] } ] }, { "description": "CATH EVERCROSS EV3 7X100 MM", "code_information": [ { "code": "C1725", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 462.76, "10th_percentile": 256.45, "90th_percentile": 2515.23, "count": "21" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 270.69, "10th_percentile": 106.59, "90th_percentile": 1342.29, "count": "14" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 484.0, "10th_percentile": 143.56, "90th_percentile": 543.74, "count": "1 through 10" } ] } ] }, { "description": "PROXIMAL FEMUR HOOK PLATE 4.5M", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "VAGINAL DELIVERY W STERILIZATION &OR D&C - SOI : 4", "code_information": [ { "code": "5414", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 19932.1, "maximum": 29121.2, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 29121.2 } ] } ] }, { "description": "SCREW BONE 3.5X65 SELF TPNG", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "CANN BNE SCREW 7.3X16X65MM", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "HIP STEM SIZE 5", "code_information": [ { "code": "C1776", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 4588.1, "10th_percentile": 1617.12, "90th_percentile": 11630.3, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 9120.0, "10th_percentile": 9120.0, "90th_percentile": 9120.0, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 8640.0, "10th_percentile": 8640.0, "90th_percentile": 9120.0, "count": "1 through 10" } ] } ] }, { "description": "METANEPHRINES FRACT", "code_information": [ { "code": "83835", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 237.6, "discounted_cash": 45.0, "minimum": 14.7378, "maximum": 249.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 16.6, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.91 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 68.44 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 14.74 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.91 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 76.06 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 76.06 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 161.57, "10th_percentile": 161.57, "90th_percentile": 161.57, "count": "1 through 10" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 25.41, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 23.72, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 17.96, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 45.14, "10th_percentile": 45.14, "90th_percentile": 156.87, "count": "1 through 10" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 27.95, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 17.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.34 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 33.46 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 30.17 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.91 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.57 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 27.95, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "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": "fee schedule", "standard_charge_dollar": 23.21 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 16.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 27.73 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 25.41, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "INFECTIOUS & PARASITIC DISEASES INCLUDING HIV W O.R. PROCEDURE - SOI : 4", "code_information": [ { "code": "7104", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 76807.0, "maximum": 81415.42, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 80012.23 } ] } ] }, { "description": "CALCIUM GLUC 1,000MG/50ML", "drug_information": { "unit": 50.0, "type": "ML" }, "code_information": [ { "code": "44567062024", "type": "NDC" }, { "code": "J0612", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 40.46, "10th_percentile": 40.46, "90th_percentile": 40.46, "count": "1 through 10" } ] } ] }, { "description": "OTHER RESPIRATORY DIAGNOSES EXCEPT SIGNS, SYMPTOMS AND MISCELLANEOUS DIAGNOSES- SOI : 1", "code_information": [ { "code": "1431", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 6028.05, "maximum": 6389.73, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 6279.6 } ] } ] }, { "description": "LOWER EXTREMITY ARTERIAL PROCEDURES - SOI : 1", "code_information": [ { "code": "1811", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 17570.35, "maximum": 18624.57, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 18303.57 } ] } ] }, { "description": "BONE CEMENT TRAUMA INJECTABLE", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "CATH BALLOON SLEEK 3X22MM272", "code_information": [ { "code": "C1725", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 462.76, "10th_percentile": 256.45, "90th_percentile": 2515.23, "count": "21" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 270.69, "10th_percentile": 106.59, "90th_percentile": 1342.29, "count": "14" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 484.0, "10th_percentile": 143.56, "90th_percentile": 543.74, "count": "1 through 10" } ] } ] }, { "description": "INTMD RPR N-HF/GENIT7.6-12.5", "code_information": [ { "code": "12044", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1676.94, "discounted_cash": 318.0, "minimum": 251.541, "maximum": 1341.552, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 294.54, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 661.04 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 352.88 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 735.59 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 735.59 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 450.83, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 420.77, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 318.58, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 495.91, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 315.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 315.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 495.91, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 300.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 300.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 300.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 450.83, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "FULL THICKNESS BURN WITH SKIN GRAFT OR INHALATION INJURY WITHOUT CCMCC", "code_information": [ { "code": "929", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 14899.3, "maximum": 44285.4, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 14899.3 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 30877.81 } ] } ] }, { "description": "PLATE TUBULAR 1/3 10 HOL", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "INSERT DM LINER HEAD 0 28MM", "code_information": [ { "code": "C1776", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 4588.1, "10th_percentile": 1617.12, "90th_percentile": 11630.3, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 9120.0, "10th_percentile": 9120.0, "90th_percentile": 9120.0, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 8640.0, "10th_percentile": 8640.0, "90th_percentile": 9120.0, "count": "1 through 10" } ] } ] }, { "description": "NONSPECIFIC CEREBROVASCULAR DISORDERS WITH CC", "code_information": [ { "code": "071", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 7956.35, "maximum": 24769.8, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 7956.35 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 9836.26 } ] } ] }, { "description": "NEONATE BIRTHWT 1000-1249G W OR WO OTHER SIGNIFICANT CONDITION - SOI : 4", "code_information": [ { "code": "6034", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 199638.04, "maximum": 211616.32, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 207969.12 } ] } ] }, { "description": "OTHER SIGNIFICANT HIP & FEMUR SURGERY - SOI : 2", "code_information": [ { "code": "3092", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 25980.2, "maximum": 27539.01, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 27064.38 } ] } ] }, { "description": "DISORDERS OF THE BILIARY TRACT WITHOUT CCMCC", "code_information": [ { "code": "446", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 3769.2116, "maximum": 16513.2, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 5727.82 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 7931.33 } ] } ] }, { "description": "SCREW UNIVERSAL 15MM", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "NEPHRITIS & NEPHROSIS - SOI : 2", "code_information": [ { "code": "4622", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 10509.93, "maximum": 11140.52, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 10948.52 } ] } ] }, { "description": "NEONATE BWT 2000-2499G W OTHER SIGNIFICANT CONDITION - SOI : 1", "code_information": [ { "code": "6251", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 14632.72, "maximum": 15510.69, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 15243.36 } ] } ] }, { "description": "NEONATE, BIRTHWT >2499G W RESP DIST SYNDOTH MAJ RESP COND - SOI : 1", "code_information": [ { "code": "6341", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 9235.94, "maximum": 9790.1, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 9621.37 } ] } ] }, { "description": "AMYLASE SERUM", "code_information": [ { "code": "82150", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 207.63, "discounted_cash": 39.0, "minimum": 5.6376, "maximum": 166.104, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 75.0, "median_amount": 155.72, "10th_percentile": 155.72, "90th_percentile": 155.72, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.35, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.15 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 26.18 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5.64 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.15 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 29.1 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 29.1 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 128.35, "10th_percentile": 116.27, "90th_percentile": 141.19, "count": "1 through 10" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.72, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 9.07, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 6.87, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 39.45, "10th_percentile": 37.37, "90th_percentile": 188.75, "count": "12" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.69, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 6.8, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.7 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.8 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.8, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 11.54 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.15 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.08 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10.69, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.88 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 39.45, "10th_percentile": 39.45, "90th_percentile": 39.45, "count": "1 through 10" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 39.45, "10th_percentile": 37.37, "90th_percentile": 40.28, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 10.61 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9.72, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "STENT PARAMOUNT MINI GPS", "code_information": [ { "code": "C1874", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 4258.8, "10th_percentile": 4258.8, "90th_percentile": 4420.0, "count": "1 through 10" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1456.46, "10th_percentile": 975.0, "90th_percentile": 4680.0, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1444.95, "10th_percentile": 1444.95, "90th_percentile": 1444.95, "count": "1 through 10" } ] } ] }, { "description": "ADJUSTMENT DISORDERS & NEUROSES EXCEPT DEPRESSIVE DIAGNOSES - SOI : 4", "code_information": [ { "code": "7554", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 21085.75, "maximum": 22350.9, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 21965.68 } ] } ] }, { "description": "SCREW LCKNG METAGIENE 4.5X24", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "SCREW CAPTURED GOLD 5X80", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "OT SELF MGMT TRN 15 MIN", "code_information": [ { "code": "97535", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 169.32, "discounted_cash": 32.0, "minimum": 25.398, "maximum": 135.456, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 30.87, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 94.74 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 30.42 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 105.23 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 105.23 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 47.25, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 44.1, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 33.39, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 36.13, "10th_percentile": 32.85, "90th_percentile": 64.34, "count": "1 through 10" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 51.98, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 33.08, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 33.08, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 24.6, "median_amount": 43.2, "10th_percentile": 43.2, "90th_percentile": 86.4, "count": "1 through 10" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 51.98, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 31.5, "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": 19.0, "median_amount": 32.17, "10th_percentile": 32.17, "90th_percentile": 96.51, "count": "1 through 10" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 31.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 31.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 36.13, "10th_percentile": 30.48, "90th_percentile": 64.34, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 79.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 47.25, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "NEONATE, TRANSFERRED <5 DAYS OLD, NOT BORN HERE - SOI : 4", "code_information": [ { "code": "5804", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 14645.14, "maximum": 15523.85, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 15256.3 } ] } ] }, { "description": "NEO BWT<500G OR 500-999G & GA<24WKS OR 500-749G W MAJ ANOM OR WOUT LIFE SUSTAINING INTERVENTION- SOI : 3", "code_information": [ { "code": "5893", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 176116.04, "maximum": 186683.0, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 183465.53 } ] } ] }, { "description": "SZ 6 STD FEMORAL STEM", "code_information": [ { "code": "C1776", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 4588.1, "10th_percentile": 1617.12, "90th_percentile": 11630.3, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 9120.0, "10th_percentile": 9120.0, "90th_percentile": 9120.0, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 8640.0, "10th_percentile": 8640.0, "90th_percentile": 9120.0, "count": "1 through 10" } ] } ] }, { "description": "MAXORD EXTRA ROPE AG 1X12", "code_information": [ { "code": "A6199", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 12.74, "10th_percentile": 12.73, "90th_percentile": 12.74, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 11.34, "10th_percentile": 11.34, "90th_percentile": 11.34, "count": "1 through 10" } ] } ] }, { "description": "MASTECTOMY PROCEDURES - SOI : 3", "code_information": [ { "code": "3623", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 28032.53, "maximum": 29714.48, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 29202.35 } ] } ] }, { "description": "O.R. PROCEDURES WITH PRINCIPAL DIAGNOSIS OF MENTAL ILLNESS", "code_information": [ { "code": "876", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 28858.0, "maximum": 55544.4, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 28858.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 37052.8 } ] } ] }, { "description": "MALL SCREW 2334-55", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "INJ W/FLUOR EVAL CV DEV", "code_information": [ { "code": "36598", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 981.5, "discounted_cash": 186.0, "minimum": 65.92, "maximum": 785.2, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 84.76, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 89.13 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 65.92 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 99.34 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 99.34 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 129.74, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 121.09, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 91.68, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 142.71, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 90.81, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 90.81, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 142.71, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 86.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 86.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 86.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 129.74, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "D&C, CONIZATION, LAPAROSCOPY AND TUBAL INTERRUPTION WITH CCMCC", "code_information": [ { "code": "744", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 8284.692, "maximum": 33777.0, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 13036.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 19644.72 } ] } ] }, { "description": "CATH MONORAIL 15MMX4.0", "code_information": [ { "code": "C1725", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 462.76, "10th_percentile": 256.45, "90th_percentile": 2515.23, "count": "21" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 270.69, "10th_percentile": 106.59, "90th_percentile": 1342.29, "count": "14" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 484.0, "10th_percentile": 143.56, "90th_percentile": 543.74, "count": "1 through 10" } ] } ] }, { "description": "STEALTH ATHERECTOMY DEVICE 360", "code_information": [ { "code": "C1724", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 6662.35, "10th_percentile": 6662.35, "90th_percentile": 7698.41, "count": "1 through 10" } ] } ] }, { "description": "GUIDEWIRE MICROPUNCTURE", "code_information": [ { "code": "C1769", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 228.66, "10th_percentile": 43.17, "90th_percentile": 1333.19, "count": "49" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 200.16, "10th_percentile": 45.57, "90th_percentile": 746.52, "count": "29" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 130.22, "10th_percentile": 39.18, "90th_percentile": 442.41, "count": "15" } ] } ] }, { "description": "NEONATE BIRTHWT 1500-1999G W CONGENITALPERINATAL INFECTION - SOI : 4", "code_information": [ { "code": "6134", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 118707.29, "maximum": 125829.72, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 123661.05 } ] } ] }, { "description": "CANC SCREW 2333-60", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "INSERT RT SZ 3-4 9MM", "code_information": [ { "code": "C1776", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 4588.1, "10th_percentile": 1617.12, "90th_percentile": 11630.3, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 9120.0, "10th_percentile": 9120.0, "90th_percentile": 9120.0, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 8640.0, "10th_percentile": 8640.0, "90th_percentile": 9120.0, "count": "1 through 10" } ] } ] }, { "description": "CATH CORDIS 7FR JR6", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 168.56, "10th_percentile": 168.56, "90th_percentile": 168.56, "count": "1 through 10" } ] } ] }, { "description": "RESURFACING PATELLA SZ 3", "code_information": [ { "code": "C1776", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 4588.1, "10th_percentile": 1617.12, "90th_percentile": 11630.3, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 9120.0, "10th_percentile": 9120.0, "90th_percentile": 9120.0, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 8640.0, "10th_percentile": 8640.0, "90th_percentile": 9120.0, "count": "1 through 10" } ] } ] }, { "description": "ANGIOSCULPT RX PTCA TAPER 3.0X - C1725 - 900264", "code_information": [ { "code": "C1725", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 462.76, "10th_percentile": 256.45, "90th_percentile": 2515.23, "count": "21" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 270.69, "10th_percentile": 106.59, "90th_percentile": 1342.29, "count": "14" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 484.0, "10th_percentile": 143.56, "90th_percentile": 543.74, "count": "1 through 10" } ] } ] }, { "description": "XR BONE SURVEY INFANT", "code_information": [ { "code": "77076", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 756.25, "discounted_cash": 143.0, "minimum": 41.6598, "maximum": 605.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 41.66, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 135.95 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 452.8 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 97.51 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 135.95 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 503.24 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 503.24 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 63.77, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 59.51, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 45.06, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 70.14, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 44.64, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 144.11 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 190.28 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 44.64, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 171.59 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 135.95 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 179.51 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 70.14, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 42.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 131.99 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 42.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 42.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 109.07 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 63.77, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "METHADONES SCREEN UR/CONF(REF)", "code_information": [ { "code": "80358", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 120.0, "discounted_cash": 22.0, "minimum": 17.98, "maximum": 96.0, "payers_information": [ { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.52 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.52 }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.63 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.92 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 23.37 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.52 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.45 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.98 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 26.66 } ] } ] }, { "description": "CATH DILATION SABER 4X20X150", "code_information": [ { "code": "C1725", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 462.76, "10th_percentile": 256.45, "90th_percentile": 2515.23, "count": "21" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 270.69, "10th_percentile": 106.59, "90th_percentile": 1342.29, "count": "14" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 484.0, "10th_percentile": 143.56, "90th_percentile": 543.74, "count": "1 through 10" } ] } ] }, { "description": "MULTIPLE SCLEROSIS, OTHER DEMYELINATING DISEASE AND INFLAMMATORY NEUROPATHIES- SOI : 4", "code_information": [ { "code": "0434", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 135117.29, "maximum": 143224.33, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 140755.86 } ] } ] }, { "description": "TREAT FINGER FRACTURE EACH - 26735 - ", "code_information": [ { "code": "26735", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 13125.0, "discounted_cash": 2493.0, "minimum": 1303.9782, "maximum": 10500.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1303.98, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 3640.81 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 1943.59 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 4051.43 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 4051.43 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1995.89, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 1862.83, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 1410.43, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2195.47, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1397.12, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1397.12, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2195.47, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1330.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1330.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 1330.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1995.89, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "MYOGLOBIN URINE", "code_information": [ { "code": "83874", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 171.27, "discounted_cash": 44.0, "minimum": 11.2404, "maximum": 188.4, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12.66, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.23 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 52.2 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 11.24 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.23 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 58.01 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 58.01 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.38, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 18.09, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 13.7, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.32, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 13.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.32 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.52 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 23.01 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.23 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.07 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.32, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.7 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 44.75, "10th_percentile": 44.75, "90th_percentile": 44.75, "count": "1 through 10" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 12.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 21.14 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.38, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "STENT SENTINOL L40XL135C", "code_information": [ { "code": "C1876", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 3100.8, "10th_percentile": 1880.29, "90th_percentile": 7522.24, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 3482.69, "10th_percentile": 3482.69, "90th_percentile": 3482.69, "count": "1 through 10" } ] } ] }, { "description": "OTHER CARDIOTHORACIC & THORACIC VASCULAR PROCEDURES - SOI : 2", "code_information": [ { "code": "1672", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 46629.51, "maximum": 49427.28, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 48575.41 } ] } ] }, { "description": "SCREW SELF TAPPING CORTEX 2.7M", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "GLIDEWIRE ADVANTAGE EXTRA STIF", "code_information": [ { "code": "C1725", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 462.76, "10th_percentile": 256.45, "90th_percentile": 2515.23, "count": "21" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 270.69, "10th_percentile": 106.59, "90th_percentile": 1342.29, "count": "14" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 484.0, "10th_percentile": 143.56, "90th_percentile": 543.74, "count": "1 through 10" } ] } ] }, { "description": "RUSH PIN 3.2MM X203MM", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "SCREW LAG DHS DCS 14X105M", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "MALIGNANT BREAST DISORDERS - SOI : 1", "code_information": [ { "code": "3821", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 7783.36, "maximum": 8250.37, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 8108.17 } ] } ] }, { "description": "Removal of foot foreign body - 28192 - OR36028192", "code_information": [ { "code": "28192", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1767.5, "discounted_cash": 335.0, "minimum": 265.125, "maximum": 1767.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 658.2, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 1767.5 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 974.55 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 1767.5 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 1767.5 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1007.45, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 940.28, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 711.93, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1108.19, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 705.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 705.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1108.19, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 671.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 671.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 671.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1007.45, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "NAIL TFN 11MMX480MM LONG", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "ABORTION WITH D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY- SOI : 2", "code_information": [ { "code": "5432", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 7051.82, "maximum": 7474.93, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 7346.1 } ] } ] }, { "description": "TIBIAL INSERT SZ 1 RIGHT 10MM", "code_information": [ { "code": "C1776", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 4588.1, "10th_percentile": 1617.12, "90th_percentile": 11630.3, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 9120.0, "10th_percentile": 9120.0, "90th_percentile": 9120.0, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 8640.0, "10th_percentile": 8640.0, "90th_percentile": 9120.0, "count": "1 through 10" } ] } ] }, { "description": "STENT RESOLUTE INTEGRITY 3X22M - C1876 - 900176", "code_information": [ { "code": "C1876", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 3100.8, "10th_percentile": 1880.29, "90th_percentile": 7522.24, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 3482.69, "10th_percentile": 3482.69, "90th_percentile": 3482.69, "count": "1 through 10" } ] } ] }, { "description": "STENT FRONTIER ONYX 2.25 X 38M", "code_information": [ { "code": "C1874", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 4258.8, "10th_percentile": 4258.8, "90th_percentile": 4420.0, "count": "1 through 10" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1456.46, "10th_percentile": 975.0, "90th_percentile": 4680.0, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1444.95, "10th_percentile": 1444.95, "90th_percentile": 1444.95, "count": "1 through 10" } ] } ] }, { "description": "KENALOG-40", "drug_information": { "unit": 1.0, "type": "ML" }, "code_information": [ { "code": "00003029305", "type": "NDC" }, { "code": "J3301", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 46.73, "10th_percentile": 46.73, "90th_percentile": 46.73, "count": "1 through 10" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 17.81, "10th_percentile": 15.02, "90th_percentile": 31.71, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 15.85, "10th_percentile": 15.85, "90th_percentile": 15.85, "count": "1 through 10" } ] } ] }, { "description": "EN SNARE SYSTEM 12MM-20MMX", "code_information": [ { "code": "C1725", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 462.76, "10th_percentile": 256.45, "90th_percentile": 2515.23, "count": "21" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 270.69, "10th_percentile": 106.59, "90th_percentile": 1342.29, "count": "14" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 484.0, "10th_percentile": 143.56, "90th_percentile": 543.74, "count": "1 through 10" } ] } ] }, { "description": "NEONATE BWT 1500-1999G W OR WO OTHER SIGNIFICANT CONDITION - SOI : 3", "code_information": [ { "code": "6143", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 45001.21, "maximum": 47701.29, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 46879.16 } ] } ] }, { "description": "KLOR-CON 10", "drug_information": { "unit": 10.0, "type": "EA" }, "code_information": [ { "code": "66758016013", "type": "NDC" }, { "code": "J3490", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 4.72, "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 2.28, "10th_percentile": 0.64, "90th_percentile": 22.8, "count": "56" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 5.47, "10th_percentile": 1.14, "90th_percentile": 22.8, "count": "54" } ] } ] }, { "description": "KIDNEY & URINARY TRACT MALIGNANCY - SOI : 1", "code_information": [ { "code": "4611", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 10623.58, "maximum": 11260.99, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 11066.91 } ] } ] }, { "description": "EYE INFECTIONS AND OTHER EYE DISORDERS - SOI : 4", "code_information": [ { "code": "0824", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 33513.35, "maximum": 35524.15, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 34911.9 } ] } ] }, { "description": "CARDIAC ARREST, UNEXPLAINED WITH CC", "code_information": [ { "code": "297", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 3253.8428, "maximum": 9757.8, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 6686.44 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 6078.16 } ] } ] }, { "description": "SCREW FREELOK 12.7SD", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "STENT RESOLUTE ONYX 2.5X30MM", "code_information": [ { "code": "C1874", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 4258.8, "10th_percentile": 4258.8, "90th_percentile": 4420.0, "count": "1 through 10" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1456.46, "10th_percentile": 975.0, "90th_percentile": 4680.0, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1444.95, "10th_percentile": 1444.95, "90th_percentile": 1444.95, "count": "1 through 10" } ] } ] }, { "description": "OTHER DIGESTIVE SYSTEM DIAGNOSES - SOI : 4", "code_information": [ { "code": "2544", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 36756.58, "maximum": 38961.97, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 38290.47 } ] } ] }, { "description": "OTHER NON-HYPOVOLEMIC ELECTROLYTE DISORDERS - SOI : 2", "code_information": [ { "code": "4252", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 5519.03, "maximum": 5850.17, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 5749.34 } ] } ] }, { "description": "LOCKING SCREW 2.4MM", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "RESTRATA RWM1-1X3(SQ CM)", "code_information": [ { "code": "A2007", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 3040.95, "10th_percentile": 3040.95, "90th_percentile": 5868.5, "count": "1 through 10" } ] } ] }, { "description": "H TIBIAL BASEPLATE", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "PLATE DHS 5 HOLSE 24MM", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "Ear Irrigation", "code_information": [ { "code": "69209", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 374.89, "discounted_cash": 71.0, "minimum": 23.5004, "maximum": 299.912, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 23.5, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 73.16 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 39.06 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 81.41 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 81.41 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 209.94, "10th_percentile": 209.94, "90th_percentile": 209.94, "count": "1 through 10" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 35.97, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 33.57, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 25.42, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 39.57, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 25.18, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.18, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 39.57, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 23.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 23.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 23.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 35.97, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "PHENOTYPE INFECT AGENT DRUG", "code_information": [ { "code": "87900", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 651.75, "discounted_cash": 123.0, "minimum": 97.7625, "maximum": 585.27, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 127.74, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 183.94 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 526.61 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 113.4 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 183.94 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 585.27 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 585.27 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 195.53, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 182.49, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 138.17, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 215.08, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 136.87, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 194.97 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 257.44 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 136.87, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 232.15 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 183.94 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 242.87 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 215.08, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 130.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 178.58 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 130.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 130.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 213.38 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 195.53, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "MALFUNCTION,REACTION,COMPLICATION OF CARDIACVASC DEVICE OR PROCEDURE - SOI : 2", "code_information": [ { "code": "2062", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 9947.43, "maximum": 10544.27, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 10362.54 } ] } ] }, { "description": "HYDRATE IV INFUSION ADD-ON(OB)", "code_information": [ { "code": "96361", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 203.14, "discounted_cash": 48.0, "minimum": 11.9103, "maximum": 203.168, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.66, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 37.1 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 11.91 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 41.21 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 41.21 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 28.56, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 26.66, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 20.18, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 434.22, "10th_percentile": 54.19, "90th_percentile": 1523.58, "count": "199" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 31.42, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 19.99, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.99, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 31.42, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 19.04, "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": 19.0, "median_amount": 337.73, "10th_percentile": 48.25, "90th_percentile": 771.95, "count": "61" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 19.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 19.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 365.66, "10th_percentile": 108.38, "90th_percentile": 812.83, "count": "39" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 28.56, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "TRANSFUSION EACH OTHER", "code_information": [ { "code": "36455", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1553.0, "discounted_cash": 295.0, "minimum": 175.8218, "maximum": 1242.4, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 175.82, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 516.09 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 275.51 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 574.3 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 574.3 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 269.12, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 251.17, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 190.17, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 296.03, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 188.38, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 188.38, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 296.03, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 179.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 179.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 179.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 269.12, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "SCREW 3.5MMX45MM SM FRAG", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "PLATE VA-LCP 2.7X3.5 MM", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITHOUT CCMCC", "code_information": [ { "code": "096", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 16655.8, "maximum": 41283.0, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 16655.8 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 24726.79 } ] } ] }, { "description": "IADNA-DNA/RNA PROBE TQ 12-25", "code_information": [ { "code": "87507", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2292.29, "discounted_cash": 435.0, "minimum": 343.8435, "maximum": 1871.34, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 408.44, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 588.12 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 1683.79 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 362.6 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 588.12 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1871.34 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 1871.34 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 625.17, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 583.49, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 441.79, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 489.17, "10th_percentile": 489.17, "90th_percentile": 489.17, "count": "1 through 10" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 687.69, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 437.62, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 623.41 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 823.14 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 437.62, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 742.29 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 588.12 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 776.55 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 687.69, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 416.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 570.99 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 416.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 416.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 680.62 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 625.17, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "AEROMONAS/PLESIOMONAS CULT", "code_information": [ { "code": "87081", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 161.9, "discounted_cash": 46.0, "minimum": 5.7681, "maximum": 195.2, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 75.0, "median_amount": 6.63, "10th_percentile": 6.63, "90th_percentile": 6.63, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.5, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.35 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 26.79 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5.77 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.35 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 29.77 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 29.77 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.95, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 9.28, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 7.03, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.94, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 6.96, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.91 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.09 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.96, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 11.8 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.35 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.35 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10.94, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 6.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.08 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 6.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 10.86 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9.95, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "CESAREAN DELIVERY - SOI : 2", "code_information": [ { "code": "5402", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 6900.93, "maximum": 10082.4, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 10082.4 } ] } ] }, { "description": "ENDOLUMINL IVUS OCT C 1ST", "code_information": [ { "code": "92978", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 9889.75, "discounted_cash": 1879.0, "minimum": 87.4785, "maximum": 7911.8, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 272.49 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 87.48 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 302.66 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 302.66 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 5538.26, "10th_percentile": 5538.26, "90th_percentile": 5538.26, "count": "1 through 10" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1879.05, "10th_percentile": 1483.46, "90th_percentile": 19669.06, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1879.05, "10th_percentile": 1879.05, "90th_percentile": 1879.05, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1879.05, "10th_percentile": 1879.05, "90th_percentile": 1879.05, "count": "1 through 10" } ] } ] }, { "description": "Candida Antibodies, Qualitativ", "code_information": [ { "code": "86628", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 105.9, "discounted_cash": 20.0, "minimum": 10.4487, "maximum": 84.72, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11.77, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.95 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 48.52 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 10.45 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.95 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 53.92 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 53.92 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.02, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 16.81, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 12.73, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.82, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.97 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.73 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 21.4 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.95 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.39 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.82, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.46 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 12.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 19.66 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.02, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "XR SKULL 4 + V", "code_information": [ { "code": "70260", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 607.0, "discounted_cash": 115.0, "minimum": 41.6598, "maximum": 503.24, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 41.66, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 135.95 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 452.8 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 97.51 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 135.95 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 503.24 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 503.24 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 63.77, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 59.51, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 45.06, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 70.14, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 44.64, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 144.11 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 190.28 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 44.64, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "QTC Medical Group", "plan_name": "QTC Medical Group", "methodology": "fee schedule", "standard_charge_dollar": 97.59 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 171.59 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 135.95 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 179.51 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 70.14, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 42.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 131.99 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 42.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 42.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 109.07 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 63.77, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "STENT L59M L135CM OD6MM", "code_information": [ { "code": "C1876", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 3100.8, "10th_percentile": 1880.29, "90th_percentile": 7522.24, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 3482.69, "10th_percentile": 3482.69, "90th_percentile": 3482.69, "count": "1 through 10" } ] } ] }, { "description": "RENIN", "code_information": [ { "code": "84244", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 303.88, "discounted_cash": 4.0, "minimum": 3.75, "maximum": 243.104, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 21.55, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.02 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 88.84 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 19.13 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.02 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 98.74 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 98.74 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 32.99, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 30.79, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 23.31, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 36.28, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 23.09, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 32.89 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 43.42 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.09, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 39.16 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.02 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 40.96 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 36.28, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "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": "fee schedule", "standard_charge_dollar": 30.12 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 21.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 21.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 36.01 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 32.99, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "PLEURAL EFFUSION WITH MCC", "code_information": [ { "code": "186", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 7126.4976, "maximum": 33026.4, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 10153.2 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 14941.34 } ] } ] }, { "description": "ASTHMA - SOI : 3", "code_information": [ { "code": "1413", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 8462.38, "maximum": 8970.12, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 8815.52 } ] } ] }, { "description": "4.0 CANNULATED SCREW - C1713 - 043843", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "STENT XIENCE ALPINE 2.75X28 M", "code_information": [ { "code": "C1876", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 3100.8, "10th_percentile": 1880.29, "90th_percentile": 7522.24, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 3482.69, "10th_percentile": 3482.69, "90th_percentile": 3482.69, "count": "1 through 10" } ] } ] }, { "description": "O&P SMEAR CONC ID/OVA & PARASI", "code_information": [ { "code": "87177", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 198.0, "discounted_cash": 37.0, "minimum": 7.743, "maximum": 158.4, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 75.0, "median_amount": 8.9, "10th_percentile": 8.9, "90th_percentile": 8.9, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.72, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.57 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 35.96 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 7.74 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.57 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 39.96 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 39.96 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 134.64, "10th_percentile": 134.64, "90th_percentile": 134.64, "count": "1 through 10" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13.35, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 12.46, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 9.43, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.69, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 9.35, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.32 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.59 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.35, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 15.86 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.57 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.59 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.69, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "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": "fee schedule", "standard_charge_dollar": 12.2 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 8.9, "10th_percentile": 8.9, "90th_percentile": 37.62, "count": "1 through 10" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 8.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 14.57 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 13.35, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "HLTH BHVR IVNTJ INDV F2F INT30", "code_information": [ { "code": "96158", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 392.7, "discounted_cash": 74.0, "minimum": 58.905, "maximum": 314.16, "payers_information": [ { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 119.08, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 75.78, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 75.78, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 119.08, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 72.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 72.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 72.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 118.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 108.26, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 70.73, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 212.84 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 68.33 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 236.41 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 236.41 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 108.26, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 101.04, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 76.5, "additional_payer_notes": "106.00% of Medicare Rates" } ] } ] }, { "description": "TIBIAL 45MM A/P 70MM M/L MED", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "GUIDEWIRE SUPER 182CM", "code_information": [ { "code": "C1769", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 228.66, "10th_percentile": 43.17, "90th_percentile": 1333.19, "count": "49" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 200.16, "10th_percentile": 45.57, "90th_percentile": 746.52, "count": "29" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 130.22, "10th_percentile": 39.18, "90th_percentile": 442.41, "count": "15" } ] } ] }, { "description": "CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH CC", "code_information": [ { "code": "847", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 6165.9536, "maximum": 29273.4, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 7728.02 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 12541.71 } ] } ] }, { "description": "CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITH MCC", "code_information": [ { "code": "414", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 16742.559, "maximum": 57045.6, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 33258.6 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 34154.65 } ] } ] }, { "description": "STENT XIENCE ALPINE 2.25X12MM", "code_information": [ { "code": "C1876", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 3100.8, "10th_percentile": 1880.29, "90th_percentile": 7522.24, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 3482.69, "10th_percentile": 3482.69, "90th_percentile": 3482.69, "count": "1 through 10" } ] } ] }, { "description": "PARTIAL THICKNESS BURNS WO SKIN GRAFT - SOI : 2", "code_information": [ { "code": "8442", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 8236.04, "maximum": 8730.2, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 8579.74 } ] } ] }, { "description": "CHOLECYSTECTOMY WITH C.D.E. WITHOUT CCMCC", "code_information": [ { "code": "413", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 7995.6052, "maximum": 21016.8, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 15781.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 15919.21 } ] } ] }, { "description": "STENT XIENCE SIERRA 3.0X33", "code_information": [ { "code": "C1874", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 4258.8, "10th_percentile": 4258.8, "90th_percentile": 4420.0, "count": "1 through 10" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1456.46, "10th_percentile": 975.0, "90th_percentile": 4680.0, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1444.95, "10th_percentile": 1444.95, "90th_percentile": 1444.95, "count": "1 through 10" } ] } ] }, { "description": "CONTRAST BATH 15 MIN", "code_information": [ { "code": "97034", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 108.0, "discounted_cash": 20.0, "minimum": 13.3868, "maximum": 86.4, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13.39, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 42.01 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 13.49 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 46.66 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 46.66 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 20.49, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 19.12, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 14.48, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 22.54, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 14.34, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.34, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 22.54, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 13.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 13.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 79.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 20.49, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "VAGINAL DELIVERY W COMPLICATING PROCEDURES EXC STERILIZATION &OR D&C - SOI : 1", "code_information": [ { "code": "5421", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 4456.1, "maximum": 6510.45, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 6510.45 } ] } ] }, { "description": "CATH MAVERICK 30MM X 4.0", "code_information": [ { "code": "C1725", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 462.76, "10th_percentile": 256.45, "90th_percentile": 2515.23, "count": "21" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 270.69, "10th_percentile": 106.59, "90th_percentile": 1342.29, "count": "14" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 484.0, "10th_percentile": 143.56, "90th_percentile": 543.74, "count": "1 through 10" } ] } ] }, { "description": "EGD LESION ABLATION", "code_information": [ { "code": "43270", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3442.32, "discounted_cash": 654.0, "minimum": 516.348, "maximum": 2753.856, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 764.73, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 2071.34 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 1105.75 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 2304.95 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 2304.95 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1170.51, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 1092.48, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 827.16, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1287.56, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 819.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 819.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1287.56, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 780.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 780.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 780.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1170.51, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "US PREG > 14 WKS ADDL GESTATIO", "code_information": [ { "code": "76810", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 891.0, "discounted_cash": 169.0, "minimum": 37.6275, "maximum": 712.8, "payers_information": [ { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 91.44 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 174.73 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 37.63 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 91.44 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 194.19 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 194.19 }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 96.93 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 127.99 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 115.41 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 91.44 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 120.74 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 88.78 } ] } ] }, { "description": "OTHER EAR, NOSE, MOUTH & THROAT PROCEDURES - SOI : 4", "code_information": [ { "code": "0984", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 61479.03, "maximum": 65167.77, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 64044.6 } ] } ] }, { "description": "IGE GARLIC", "code_information": [ { "code": "86003", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 16.3, "discounted_cash": 3.0, "minimum": 2.445, "maximum": 352.08, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5.12, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.36 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 16.3 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 4.54 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.36 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 16.3 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 16.3 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 37.06, "10th_percentile": 37.06, "90th_percentile": 222.36, "count": "1 through 10" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7.83, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 7.31, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 5.53, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.61, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.81 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.31 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 9.3 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.36 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.72 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.61, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "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": "fee schedule", "standard_charge_dollar": 7.15 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 10.36, "10th_percentile": 10.36, "90th_percentile": 10.36, "count": "1 through 10" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 8.54 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.83, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "PERMANENT CARDIAC PACEMAKER IMPLANT W AMI, HEART FAILURE OR SHOCK - SOI : 4", "code_information": [ { "code": "1704", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 60072.29, "maximum": 63676.63, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 62579.16 } ] } ] }, { "description": "SEPTICEMIA & DISSEMINATED INFECTIONS - SOI : 1", "code_information": [ { "code": "7201", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 6104.45, "maximum": 6470.72, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 6359.19 } ] } ] }, { "description": "SHOULDER, ELBOW OR FOREARM PROCEDURES, EXCEPT MAJOR JOINT PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "512", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 7186.5316, "maximum": 16513.2, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 13844.1 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 15870.32 } ] } ] }, { "description": "Fentanyl, Scr W Ref Conf, Urin", "code_information": [ { "code": "80307", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 87.5, "discounted_cash": 7.0, "minimum": 5.8575, "maximum": 960.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 60.9, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 87.5 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 87.5 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 54.06 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 87.5 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 87.5 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 87.5 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 305.11, "10th_percentile": 305.11, "90th_percentile": 336.81, "count": "1 through 10" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 87.5, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 87.0, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 65.87, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 103.52, "10th_percentile": 98.07, "90th_percentile": 116.27, "count": "44" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 87.5, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 65.25, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 87.5 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 87.5 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 65.25, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 87.5 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 87.5 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 87.5 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 87.5, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "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": "fee schedule", "standard_charge_dollar": 85.13 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 103.52, "10th_percentile": 62.14, "90th_percentile": 103.52, "count": "18" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 62.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 62.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 103.52, "10th_percentile": 54.0, "90th_percentile": 116.27, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 87.5 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 87.5, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "HISTOPLASMA ABS, QN DID(REF)", "code_information": [ { "code": "86698", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 41.23, "discounted_cash": 7.0, "minimum": 6.1845, "maximum": 151.2, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13.51, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.46 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 41.23 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.0 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.46 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 41.23 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 41.23 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 20.69, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 19.31, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 14.62, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 22.75, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 14.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.62 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.23 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 24.56 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.46 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.69 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 22.75, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 13.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.89 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 13.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 20.46 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 20.69, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "SCREW MINI 24MM", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "STENT XIENCE ALPINE 3.5X15MM", "code_information": [ { "code": "C1874", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 4258.8, "10th_percentile": 4258.8, "90th_percentile": 4420.0, "count": "1 through 10" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1456.46, "10th_percentile": 975.0, "90th_percentile": 4680.0, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1444.95, "10th_percentile": 1444.95, "90th_percentile": 1444.95, "count": "1 through 10" } ] } ] }, { "description": "ULTRASOUND ACCELERATED AND OTHER THROMBOLYSIS OF PERIPHERAL VASCULAR STRUCTURES WITH MCC", "code_information": [ { "code": "278", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 27906.2, "maximum": 53363.1594, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 27906.2 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 53363.16 } ] } ] }, { "description": "COVID-19 CLIENT CPL (SONIC)", "code_information": [ { "code": "87635", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 90.0, "discounted_cash": 13.0, "minimum": 7.65, "maximum": 90.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 50.28, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 72.4 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 51.31 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 51.31 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 72.4 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 51.31 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 51.31 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 76.97, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 71.83, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 54.39, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 84.66, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 53.88, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 76.74 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 90.0 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 53.88, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 90.0 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 72.4 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 90.0 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 84.66, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "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": "fee schedule", "standard_charge_dollar": 70.29 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 51.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 51.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 61.57 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 76.97, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "2.7 MM CORTEX SCREW", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "SCREW CORTEX SELFTAPPING 3.5X2", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "FEVER AND INFLAMMATORY CONDITIONS- SOI : 2", "code_information": [ { "code": "7222", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 5519.98, "maximum": 5851.18, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 5750.34 } ] } ] }, { "description": "GAMMA NAIL SCREW", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "XR RIBS UNI 2 V-LT", "code_information": [ { "code": "71100", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 545.92, "discounted_cash": 103.0, "minimum": 34.6822, "maximum": 436.736, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 34.68, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 112.36 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 322.43 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 69.43 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 112.36 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 358.35 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 358.35 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 371.23, "10th_percentile": 337.48, "90th_percentile": 371.23, "count": "1 through 10" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 53.09, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 49.55, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 37.51, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 163.78, "10th_percentile": 163.78, "90th_percentile": 340.51, "count": "1 through 10" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 105.91, "10th_percentile": 103.72, "90th_percentile": 398.49, "count": "1 through 10" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 58.39, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 37.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 119.1 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 157.26 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 37.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "QTC Medical Group", "plan_name": "QTC Medical Group", "methodology": "fee schedule", "standard_charge_dollar": 97.59 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 141.82 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 112.36 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 148.36 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 58.39, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 35.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 109.09 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 103.72, "10th_percentile": 103.72, "90th_percentile": 103.72, "count": "1 through 10" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 35.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 35.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 103.72, "10th_percentile": 103.72, "90th_percentile": 103.72, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 68.82 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 53.09, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "TRANSFUSION EACH NEWBORN", "code_information": [ { "code": "36450", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1480.5, "discounted_cash": 281.0, "minimum": 139.21, "maximum": 1184.4, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 175.82, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 188.23 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 139.21 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 209.79 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 209.79 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 269.12, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 251.17, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 190.17, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 296.03, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 188.38, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 188.38, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 296.03, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 179.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 179.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 179.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 269.12, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "LP S-T CRTX SCREW 28MM", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "PACEMAKER SEPHYR DR", "code_information": [ { "code": "C1785", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 6147.84, "10th_percentile": 6147.84, "90th_percentile": 6147.84, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 6147.84, "10th_percentile": 6147.84, "90th_percentile": 6147.84, "count": "1 through 10" } ] } ] }, { "description": "Factor XII Activity", "code_information": [ { "code": "85280", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 285.1, "discounted_cash": 54.0, "minimum": 16.8345, "maximum": 228.08, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.96, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.31 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 78.17 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 16.83 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.31 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 86.88 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 86.88 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 29.03, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 27.09, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 20.51, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 31.93, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 20.32, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28.94 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 38.22 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.32, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 34.46 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.31 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 36.05 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 31.93, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 19.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26.51 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 19.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 19.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 31.68 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 29.03, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "ALPHA-FETOPROTEIN SERUM(REF)", "code_information": [ { "code": "82105", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 38.03, "discounted_cash": 7.0, "minimum": 5.7045, "maximum": 198.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 16.43, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.66 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 38.03 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 14.59 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.66 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 38.03 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 38.03 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 25.16, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 23.48, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 17.78, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 27.67, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 17.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.08 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 33.11 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 29.86 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.66 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.24 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 27.67, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "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": "fee schedule", "standard_charge_dollar": 22.97 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 27.47 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 25.16, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "CANC SCREW 2333-25", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "NEONATE BWT 1250-1499G W OR WO OTHER SIGNIFICANT CONDITION - SOI : 2", "code_information": [ { "code": "6082", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 46227.45, "maximum": 49001.1, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 48156.57 } ] } ] }, { "description": "CT BILAT LOWER EXT W", "code_information": [ { "code": "73701", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2900.0, "discounted_cash": 598.0, "minimum": 69.8936, "maximum": 2518.056, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 69.89, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 227.2 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 736.17 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 158.53 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 227.2 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 818.17 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 818.17 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 2140.35, "10th_percentile": 2140.35, "90th_percentile": 2140.35, "count": "1 through 10" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 106.98, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 99.85, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 75.6, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 944.28, "10th_percentile": 944.28, "90th_percentile": 944.28, "count": "1 through 10" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 566.56, "10th_percentile": 551.0, "90th_percentile": 610.63, "count": "1 through 10" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 117.68, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 74.89, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 240.83 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 317.99 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 74.89, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 286.75 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 227.2 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 299.99 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 117.68, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 71.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 220.58 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 71.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 71.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 298.8 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 106.98, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "CVA & PRECEREBRAL OCCLUSION W INFARCT - SOI : 2", "code_information": [ { "code": "0452", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 12984.37, "maximum": 13763.43, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 13526.22 } ] } ] }, { "description": "7.3MMX20 BONE SCREW", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "INSERT EMERGENCY AIRWAY", "code_information": [ { "code": "31500", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1209.46, "discounted_cash": 229.0, "minimum": 94.3936, "maximum": 1064.328, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 94.39, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 270.84 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 144.58 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 301.39 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 301.39 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 144.48, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 134.85, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 102.1, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 217.7, "10th_percentile": 217.7, "90th_percentile": 229.8, "count": "1 through 10" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 158.93, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 101.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 101.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 158.93, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 96.32, "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": 19.0, "median_amount": 229.8, "10th_percentile": 229.8, "90th_percentile": 229.8, "count": "1 through 10" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 96.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 96.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 229.8, "10th_percentile": 229.8, "90th_percentile": 258.1, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 144.48, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "MENTAL ILLNESS DIAGNOSIS W O.R. PROCEDURE - SOI : 1", "code_information": [ { "code": "7401", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 18671.48, "maximum": 19791.77, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 19450.66 } ] } ] }, { "description": "CARDIAC CATHETERIZATION FOR CORONARY ARTERY DISEASE- SOI : 1", "code_information": [ { "code": "1911", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 10365.72, "maximum": 10987.67, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 10798.29 } ] } ] }, { "description": "DEVICE ATHERECTOMY 1.5X145", "code_information": [ { "code": "C1724", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 6662.35, "10th_percentile": 6662.35, "90th_percentile": 7698.41, "count": "1 through 10" } ] } ] }, { "description": "INSJ SUBQ CAR RHYTHM MON W/PRG", "code_information": [ { "code": "33285", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 43147.3, "discounted_cash": 8197.0, "minimum": 3297.9744, "maximum": 34517.84, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3297.97, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 10163.66 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 5425.71 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 11309.94 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 11309.94 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5047.92, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 4711.39, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 3567.2, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 7766.52, "10th_percentile": 3591.75, "90th_percentile": 17083.2, "count": "1 through 10" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5552.71, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3533.54, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3533.54, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 24.6, "median_amount": 5933.02, "10th_percentile": 5933.02, "90th_percentile": 5933.02, "count": "1 through 10" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5552.71, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3365.28, "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": 19.0, "median_amount": 7766.52, "10th_percentile": 7766.52, "90th_percentile": 7766.52, "count": "1 through 10" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3365.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 3365.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 9207.64, "10th_percentile": 9207.64, "90th_percentile": 9207.64, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5047.92, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "MAJOR BLADDER PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "655", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 9605.9018, "maximum": 24769.8, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 21114.6 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 20291.84 } ] } ] }, { "description": "TRANSIENT ISCHEMIA - SOI : 1", "code_information": [ { "code": "0471", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 7801.51, "maximum": 8269.6, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 8127.07 } ] } ] }, { "description": "DRUG WB 12 W CONF", "code_information": [ { "code": "80307", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1200.0, "discounted_cash": 7.0, "minimum": 5.8575, "maximum": 960.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 60.9, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 87.68 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 251.05 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 54.06 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 87.68 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 279.01 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 279.01 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 305.11, "10th_percentile": 305.11, "90th_percentile": 336.81, "count": "1 through 10" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 93.21, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 87.0, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 65.87, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 103.52, "10th_percentile": 98.07, "90th_percentile": 116.27, "count": "44" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 102.53, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 65.25, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 92.94 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 122.72 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 65.25, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 110.67 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 87.68 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 115.78 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 102.53, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "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": "fee schedule", "standard_charge_dollar": 85.13 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 103.52, "10th_percentile": 62.14, "90th_percentile": 103.52, "count": "18" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 62.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 62.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 103.52, "10th_percentile": 54.0, "90th_percentile": 116.27, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 95.77 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 93.21, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "ACUTE MAJOR EYE INFECTIONS WITHOUT CCMCC", "code_information": [ { "code": "122", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 2647.56, "maximum": 20266.2, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 2647.56 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 7533.46 } ] } ] }, { "description": "OTHER SMALL & LARGE BOWEL PROCEDURES - SOI : 2", "code_information": [ { "code": "2232", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 16441.52, "maximum": 17428.01, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 17127.64 } ] } ] }, { "description": "CORT SCREW 2319-36", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "FUNCT CAP EVAL (15 MIN)", "code_information": [ { "code": "97750", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 130.38, "discounted_cash": 24.0, "minimum": 19.557, "maximum": 107.4, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 32.11, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 96.69 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 31.04 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 107.4 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 107.4 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 49.16, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 45.88, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 34.74, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 54.07, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 34.41, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 34.41, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 54.07, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 32.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 32.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 32.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 79.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 49.16, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITH CC", "code_information": [ { "code": "240", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 12884.22, "maximum": 54793.8, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 17821.4 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 27327.74 } ] } ] }, { "description": "CATH MONORAIL 15MMX3.75", "code_information": [ { "code": "C1725", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 462.76, "10th_percentile": 256.45, "90th_percentile": 2515.23, "count": "21" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 270.69, "10th_percentile": 106.59, "90th_percentile": 1342.29, "count": "14" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 484.0, "10th_percentile": 143.56, "90th_percentile": 543.74, "count": "1 through 10" } ] } ] }, { "description": "GUIDING CATH XB 4 6FR", "code_information": [ { "code": "C1887", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 115.24, "10th_percentile": 81.0, "90th_percentile": 503.66, "count": "23" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 156.51, "10th_percentile": 102.6, "90th_percentile": 572.45, "count": "11" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 129.36, "10th_percentile": 24.35, "90th_percentile": 512.12, "count": "1 through 10" } ] } ] }, { "description": "BENADRYL - 00121048905", "drug_information": { "unit": 5.0, "type": "ML" }, "code_information": [ { "code": "00121048905", "type": "NDC" }, { "code": "Q0163", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 8.96, "10th_percentile": 8.96, "90th_percentile": 17.92, "count": "1 through 10" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 0.57, "10th_percentile": 0.54, "90th_percentile": 4.05, "count": "1 through 10" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 24.6, "median_amount": 0.1, "10th_percentile": 0.04, "90th_percentile": 0.1, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 0.57, "10th_percentile": 0.57, "90th_percentile": 0.57, "count": "1 through 10" } ] } ] }, { "description": "OTHER SKIN, SUBCUTANEOUS TISSUE & RELATED PROCEDURES - SOI : 3", "code_information": [ { "code": "3643", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 23511.49, "maximum": 24922.18, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 24492.65 } ] } ] }, { "description": "STENT RESOLUTE ONYX 2.75MX18", "code_information": [ { "code": "C1874", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 4258.8, "10th_percentile": 4258.8, "90th_percentile": 4420.0, "count": "1 through 10" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1456.46, "10th_percentile": 975.0, "90th_percentile": 4680.0, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1444.95, "10th_percentile": 1444.95, "90th_percentile": 1444.95, "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", "minimum": 4239.0, "maximum": 12760.2, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 4239.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 11526.45 } ] } ] }, { "description": "GUIDING CATH AL 1 6FR", "code_information": [ { "code": "C1887", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 115.24, "10th_percentile": 81.0, "90th_percentile": 503.66, "count": "23" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 156.51, "10th_percentile": 102.6, "90th_percentile": 572.45, "count": "11" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 129.36, "10th_percentile": 24.35, "90th_percentile": 512.12, "count": "1 through 10" } ] } ] }, { "description": "3.2MM GUIDE WIRE 400MM", "code_information": [ { "code": "C1769", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 228.66, "10th_percentile": 43.17, "90th_percentile": 1333.19, "count": "49" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 200.16, "10th_percentile": 45.57, "90th_percentile": 746.52, "count": "29" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 130.22, "10th_percentile": 39.18, "90th_percentile": 442.41, "count": "15" } ] } ] }, { "description": "SMEAR PRIMARY SOURCE", "code_information": [ { "code": "87207", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 125.0, "discounted_cash": 21.0, "minimum": 5.2113, "maximum": 100.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5.87, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.46 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 24.2 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5.21 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.46 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 26.9 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 26.9 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.99, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 8.39, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 6.35, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9.88, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 6.29, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.96 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.84 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.29, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 10.67 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.46 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.17 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.88, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "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": "fee schedule", "standard_charge_dollar": 8.21 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 5.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 9.82 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.99, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "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", "minimum": 7650.0, "maximum": 18550.8, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 18550.8 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 18492.36 } ] } ] }, { "description": "HYPERTENSION WITHOUT MCC", "code_information": [ { "code": "305", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 3410.393, "maximum": 15762.6, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 5330.17 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 7239.14 } ] } ] }, { "description": "IABP INSERTION", "code_information": [ { "code": "33967", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6884.63, "discounted_cash": 1189.0, "minimum": 193.45, "maximum": 5507.704, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 362.37 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 193.45 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 403.24 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 403.24 } ] } ] }, { "description": "FEMORAL WEDGE POSTERIOR SZ 4", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "OTHER MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE DIAGNOSES - SOI : 4", "code_information": [ { "code": "3514", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 46024.03, "maximum": 48785.48, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 47944.66 } ] } ] }, { "description": "MAJOR SMALL AND LARGE BOWEL PROCEDURES WITH CC", "code_information": [ { "code": "330", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 11725.102, "maximum": 36779.4, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 19816.5 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 22981.96 } ] } ] }, { "description": "CATH EUPHORA BALLOON 2.25X25MM", "code_information": [ { "code": "C1725", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 462.76, "10th_percentile": 256.45, "90th_percentile": 2515.23, "count": "21" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 270.69, "10th_percentile": 106.59, "90th_percentile": 1342.29, "count": "14" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 484.0, "10th_percentile": 143.56, "90th_percentile": 543.74, "count": "1 through 10" } ] } ] }, { "description": "Arthroscopy w/meniscectomy", "code_information": [ { "code": "29881", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 14972.4, "discounted_cash": 2844.0, "minimum": 502.3425, "maximum": 11977.92, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1303.98, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 3640.81 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 1943.59 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 4051.43 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 4051.43 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1995.89, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 1862.83, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 1410.43, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2195.47, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1397.12, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1397.12, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2195.47, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1330.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1330.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 1330.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1995.89, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "INTENTIONAL SELF-HARM AND ATTEMPTED SUICIDE- SOI : 2", "code_information": [ { "code": "8172", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 5885.75, "maximum": 6238.9, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 6131.37 } ] } ] }, { "description": "PTA FEM/POP UNILATERAL", "code_information": [ { "code": "37224", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 17681.1, "discounted_cash": 3359.0, "minimum": 2224.0414, "maximum": 14144.88, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2224.04, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 6588.7 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 3517.28 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 7331.79 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 7331.79 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3404.15, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 3177.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 2405.6, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3744.56, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2382.9, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2382.9, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3744.56, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2269.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2269.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 2269.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3404.15, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "ORTHO METAL BALL HEAD28M", "code_information": [ { "code": "C1776", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 4588.1, "10th_percentile": 1617.12, "90th_percentile": 11630.3, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 9120.0, "10th_percentile": 9120.0, "90th_percentile": 9120.0, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 8640.0, "10th_percentile": 8640.0, "90th_percentile": 9120.0, "count": "1 through 10" } ] } ] }, { "description": "DEFIB CRNT DR ICD 36J", "code_information": [ { "code": "C1721", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 11097.44, "10th_percentile": 11097.44, "90th_percentile": 11097.44, "count": "1 through 10" } ] } ] }, { "description": "FEMORAL COMPONENT RIGHT SZ 4", "code_information": [ { "code": "C1776", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 4588.1, "10th_percentile": 1617.12, "90th_percentile": 11630.3, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 9120.0, "10th_percentile": 9120.0, "90th_percentile": 9120.0, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 8640.0, "10th_percentile": 8640.0, "90th_percentile": 9120.0, "count": "1 through 10" } ] } ] }, { "description": "EVERCROSS BALLOON 4X120MM", "code_information": [ { "code": "C1725", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 462.76, "10th_percentile": 256.45, "90th_percentile": 2515.23, "count": "21" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 270.69, "10th_percentile": 106.59, "90th_percentile": 1342.29, "count": "14" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 484.0, "10th_percentile": 143.56, "90th_percentile": 543.74, "count": "1 through 10" } ] } ] }, { "description": "POSTPARTUM & POST ABORTION DIAGNOSES WO PROCEDURE - SOI : 1", "code_information": [ { "code": "5611", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 3163.96, "maximum": 3353.8, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 3296.0 } ] } ] }, { "description": "PATELLAR COMPONENT 29/8M", "code_information": [ { "code": "C1776", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 4588.1, "10th_percentile": 1617.12, "90th_percentile": 11630.3, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 9120.0, "10th_percentile": 9120.0, "90th_percentile": 9120.0, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 8640.0, "10th_percentile": 8640.0, "90th_percentile": 9120.0, "count": "1 through 10" } ] } ] }, { "description": "CATH PTCA L80CX15MXOD4FR", "code_information": [ { "code": "C1725", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 462.76, "10th_percentile": 256.45, "90th_percentile": 2515.23, "count": "21" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 270.69, "10th_percentile": 106.59, "90th_percentile": 1342.29, "count": "14" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 484.0, "10th_percentile": 143.56, "90th_percentile": 543.74, "count": "1 through 10" } ] } ] }, { "description": "TONSIL & ADENOID PROCEDURES - SOI : 4", "code_information": [ { "code": "0974", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 37437.5, "maximum": 39683.75, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 38999.81 } ] } ] }, { "description": "Remv&replc pm gen mult leads", "code_information": [ { "code": "33229", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2651.25, "discounted_cash": 503.0, "minimum": 397.6875, "maximum": 2651.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2651.25, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 2651.25 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 2651.25 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 2651.25 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 2651.25 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2651.25, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 2651.25, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 2651.25, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2651.25, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2651.25, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2651.25, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2651.25, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2651.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2651.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 2651.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2651.25, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "STENT ONYX FRONTIER 3.5X15MM", "code_information": [ { "code": "C1874", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 4258.8, "10th_percentile": 4258.8, "90th_percentile": 4420.0, "count": "1 through 10" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1456.46, "10th_percentile": 975.0, "90th_percentile": 4680.0, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1444.95, "10th_percentile": 1444.95, "90th_percentile": 1444.95, "count": "1 through 10" } ] } ] }, { "description": "MULTIPLE SIGNIFICANT TRAUMA WO O.R. PROCEDURE - SOI : 1", "code_information": [ { "code": "9301", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 11168.89, "maximum": 11839.02, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 11634.98 } ] } ] }, { "description": "THER/DIAG CONCURRENT INF(ER)", "code_information": [ { "code": "96368", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 298.48, "discounted_cash": 45.0, "minimum": 18.4962, "maximum": 1181.0, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 57.61 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 18.5 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 63.99 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 63.99 }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 63.7, "10th_percentile": 42.98, "90th_percentile": 238.78, "count": "36" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 45.37, "10th_percentile": 45.37, "90th_percentile": 45.37, "count": "13" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 45.37, "10th_percentile": 42.98, "90th_percentile": 63.7, "count": "1 through 10" } ] } ] }, { "description": "MAJOR RESPIRATORY & CHEST PROCEDURES - SOI : 2", "code_information": [ { "code": "1202", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 23084.6, "maximum": 24469.67, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 24047.94 } ] } ] }, { "description": "NEXTERONE 150 MG/100 ML BAG", "drug_information": { "unit": 100.0, "type": "ML" }, "code_information": [ { "code": "43066015010", "type": "NDC" }, { "code": "J0282", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 50.16, "10th_percentile": 2.58, "90th_percentile": 153.77, "count": "1 through 10" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 24.6, "median_amount": 10.61, "10th_percentile": 10.61, "90th_percentile": 10.61, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 50.16, "10th_percentile": 2.58, "90th_percentile": 134.32, "count": "1 through 10" } ] } ] }, { "description": "STENT XIENCE ALPINE 3.0X38MM", "code_information": [ { "code": "C1874", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 4258.8, "10th_percentile": 4258.8, "90th_percentile": 4420.0, "count": "1 through 10" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1456.46, "10th_percentile": 975.0, "90th_percentile": 4680.0, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1444.95, "10th_percentile": 1444.95, "90th_percentile": 1444.95, "count": "1 through 10" } ] } ] }, { "description": "HYPERTENSION - SOI : 2", "code_information": [ { "code": "1992", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 7649.66, "maximum": 8108.64, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 7968.89 } ] } ] }, { "description": "RPR S/N/A/GEN/TRK12.6-20.0CM", "code_information": [ { "code": "12005", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1893.61, "discounted_cash": 359.0, "minimum": 162.0038, "maximum": 1514.888, "payers_information": [ { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 272.76, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 165.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 165.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 165.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 247.97, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 162.0, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 424.95 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 226.85 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 472.87 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 472.87 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 247.97, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 231.43, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 175.23, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 272.76, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 173.58, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "OPEN EXTRACRANIAL VASCULAR PROCEDURES- SOI : 4", "code_information": [ { "code": "0244", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 57487.07, "maximum": 60936.29, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 59886.06 } ] } ] }, { "description": "VITAMIN B12", "code_information": [ { "code": "82607", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 209.0, "discounted_cash": 39.0, "minimum": 13.1196, "maximum": 167.2, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.28 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 60.92 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 13.12 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.28 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 67.71 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 67.71 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 129.2, "10th_percentile": 117.04, "90th_percentile": 142.12, "count": "32" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.62, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 21.11, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 15.98, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 39.71, "10th_percentile": 17.21, "90th_percentile": 44.6, "count": "27" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 24.88, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 15.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.56 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 29.78 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 26.86 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.28 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28.1 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 24.88, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "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": "fee schedule", "standard_charge_dollar": 20.66 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 39.71, "10th_percentile": 39.71, "90th_percentile": 39.71, "count": "33" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 40.55, "10th_percentile": 37.62, "90th_percentile": 44.6, "count": "11" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 24.67 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 22.62, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "ARTICULAR COMPONENT 80X8", "code_information": [ { "code": "C1776", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 4588.1, "10th_percentile": 1617.12, "90th_percentile": 11630.3, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 9120.0, "10th_percentile": 9120.0, "90th_percentile": 9120.0, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 8640.0, "10th_percentile": 8640.0, "90th_percentile": 9120.0, "count": "1 through 10" } ] } ] }, { "description": "CARDIAC ARREST, UNEXPLAINED WITHOUT CCMCC", "code_information": [ { "code": "298", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 2254.5076, "maximum": 8256.6, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 4192.82 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 4363.04 } ] } ] }, { "description": "SPLENIC PROCEDURES WITH CC", "code_information": [ { "code": "800", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 13629.5652, "maximum": 36802.4, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 36802.4 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 26933.72 } ] } ] }, { "description": "AMPHETAMINES CONFIRM(REF) - G0480 - 800101", "code_information": [ { "code": "G0480", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 198.0, "minimum": 18.8805, "maximum": 513.79, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 112.14, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 161.47 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 198.0 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 99.55 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 161.47 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 198.0 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 198.0 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 373.72, "10th_percentile": 373.72, "90th_percentile": 373.72, "count": "1 through 10" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 171.65, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 160.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 121.3, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 52.01, "10th_percentile": 37.62, "90th_percentile": 119.58, "count": "1 through 10" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 188.81, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 120.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 171.16 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 198.0 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 120.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 198.0 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 161.47 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 198.0 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 188.81, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 156.77 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 37.62, "10th_percentile": 22.8, "90th_percentile": 114.43, "count": "1 through 10" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 42.25, "10th_percentile": 42.25, "90th_percentile": 42.25, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 95.93 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 171.65, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "POSTPARTUM AND POST ABORTION DIAGNOSES WITHOUT O.R. PROCEDURES", "code_information": [ { "code": "776", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 3414.63, "maximum": 17263.8, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 3414.63 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 6276.61 } ] } ] }, { "description": "LOVENOX - 00075291201", "drug_information": { "unit": 0.8, "type": "ML" }, "code_information": [ { "code": "00075291201", "type": "NDC" }, { "code": "J1650", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 53.96, "10th_percentile": 44.44, "90th_percentile": 53.96, "count": "1 through 10" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 15.08, "10th_percentile": 12.7, "90th_percentile": 33.92, "count": "61" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 24.6, "median_amount": 6.31, "10th_percentile": 2.31, "90th_percentile": 15.78, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 15.08, "10th_percentile": 15.08, "90th_percentile": 30.2, "count": "34" } ] } ] }, { "description": "LITHIUM (ESKALITH) QN", "code_information": [ { "code": "80178", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 157.36, "discounted_cash": 29.0, "minimum": 5.7507, "maximum": 125.888, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.33 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 26.7 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5.75 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.33 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 29.68 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 29.68 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.92, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 9.25, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 7.01, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.91, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 6.94, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.89 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.06 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.94, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 11.78 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.33 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.32 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10.91, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 6.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.06 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 6.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 10.82 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9.92, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "MYCOPLASMA PNEUMONIAE,PCR", "code_information": [ { "code": "87581", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 187.34, "discounted_cash": 35.0, "minimum": 26.3175, "maximum": 157.55, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 34.39, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 49.51 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 141.76 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 30.53 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 49.51 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 157.55 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 157.55 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 52.64, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 49.13, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 37.2, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 57.9, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 36.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 52.48 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 69.3 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 62.49 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 49.51 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 65.38 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 57.9, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 48.07 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 57.44 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 52.64, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "027", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 7200.0, "maximum": 24247.9, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 24247.9 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 24187.04 } ] } ] }, { "description": "STENT RESOLUTE INTEGRITY 4X26", "code_information": [ { "code": "C1876", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 3100.8, "10th_percentile": 1880.29, "90th_percentile": 7522.24, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 3482.69, "10th_percentile": 3482.69, "90th_percentile": 3482.69, "count": "1 through 10" } ] } ] }, { "description": "US ABDOMEN LIVER", "code_information": [ { "code": "76705", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1083.5, "discounted_cash": 186.0, "minimum": 41.6598, "maximum": 866.8, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 75.0, "median_amount": 737.92, "10th_percentile": 737.92, "90th_percentile": 811.71, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 41.66, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 135.95 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 452.8 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 97.51 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 135.95 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 503.24 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 503.24 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 669.05, "10th_percentile": 606.08, "90th_percentile": 735.95, "count": "27" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 63.77, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 59.51, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 45.06, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 324.68, "10th_percentile": 324.68, "90th_percentile": 325.05, "count": "11" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 210.2, "10th_percentile": 194.81, "90th_percentile": 231.22, "count": "39" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 70.14, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 44.64, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 144.11 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 190.28 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 44.64, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 171.59 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 135.95 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 179.51 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 70.14, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 42.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 131.99 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 205.63, "10th_percentile": 205.63, "90th_percentile": 205.87, "count": "20" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 42.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 42.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 205.63, "10th_percentile": 194.81, "90th_percentile": 230.96, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 161.48 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 63.77, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "XR ELBOW 2+V-LT", "code_information": [ { "code": "73070", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 501.88, "discounted_cash": 95.0, "minimum": 34.6822, "maximum": 401.504, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 75.0, "median_amount": 376.41, "10th_percentile": 342.19, "90th_percentile": 376.41, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 34.68, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 112.36 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 322.43 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 69.43 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 112.36 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 358.35 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 358.35 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 310.25, "10th_percentile": 281.05, "90th_percentile": 341.28, "count": "1 through 10" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 53.09, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 49.55, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 37.51, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 150.56, "10th_percentile": 150.56, "90th_percentile": 150.56, "count": "1 through 10" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 95.36, "10th_percentile": 90.34, "90th_percentile": 107.1, "count": "12" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 58.39, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 37.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 119.1 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 157.26 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 37.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "QTC Medical Group", "plan_name": "QTC Medical Group", "methodology": "fee schedule", "standard_charge_dollar": 51.82 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange EPO/HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 27.55, "median_amount": 376.41, "10th_percentile": 376.41, "90th_percentile": 376.41, "count": "1 through 10" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 141.82 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 112.36 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 148.36 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 58.39, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 35.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 109.09 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 95.36, "10th_percentile": 95.36, "90th_percentile": 95.36, "count": "12" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 35.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 35.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 90.34, "10th_percentile": 90.34, "90th_percentile": 107.1, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 68.82 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 53.09, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "CATH ANGIOGRAPHIC LEGATO 5FR", "code_information": [ { "code": "C1887", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 115.24, "10th_percentile": 81.0, "90th_percentile": 503.66, "count": "23" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 156.51, "10th_percentile": 102.6, "90th_percentile": 572.45, "count": "11" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 129.36, "10th_percentile": 24.35, "90th_percentile": 512.12, "count": "1 through 10" } ] } ] }, { "description": "FEMORAL STEM STANDARD SZ 7", "code_information": [ { "code": "C1776", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 4588.1, "10th_percentile": 1617.12, "90th_percentile": 11630.3, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 9120.0, "10th_percentile": 9120.0, "90th_percentile": 9120.0, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 8640.0, "10th_percentile": 8640.0, "90th_percentile": 9120.0, "count": "1 through 10" } ] } ] }, { "description": "WOUND(S) CARE NON-SELECTIVE(MS", "code_information": [ { "code": "97602", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 264.67, "discounted_cash": 50.0, "minimum": 39.7005, "maximum": 828.744, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 79.96, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 264.67 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 152.02 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 264.67 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 264.67 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 122.39, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 114.23, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 86.49, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 134.62, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 85.67, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.67, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 134.62, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 81.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 81.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 81.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 122.39, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITHOUT CCMCC", "code_information": [ { "code": "959", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 12626.5356, "maximum": 28522.8, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 14834.4 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 28225.09 } ] } ] }, { "description": "GAMMA NAIL SCREW 6.28X45", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "SCREW BONE CANNULATED 7.3MM", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "OTHER VASCULAR PROCEDURES WITH MCC", "code_information": [ { "code": "252", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 15334.9926, "maximum": 41283.0, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 27343.5 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 33442.33 } ] } ] }, { "description": "ANGIOSCULPT RX PTCA TAPER 2.5X - C1725 - 900244", "code_information": [ { "code": "C1725", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 462.76, "10th_percentile": 256.45, "90th_percentile": 2515.23, "count": "21" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 270.69, "10th_percentile": 106.59, "90th_percentile": 1342.29, "count": "14" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 484.0, "10th_percentile": 143.56, "90th_percentile": 543.74, "count": "1 through 10" } ] } ] }, { "description": "Optx dst rd xartc fx/epi sep", "code_information": [ { "code": "25607", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5081.56, "discounted_cash": 965.0, "minimum": 762.234, "maximum": 5081.56, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2891.8, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 5081.56 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 4247.18 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 5081.56 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 5081.56 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4426.23, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 4131.15, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 3127.87, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 9700.35, "10th_percentile": 5302.5, "90th_percentile": 18750.0, "count": "1 through 10" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4868.85, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3098.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3098.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4868.85, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2950.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2950.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 2950.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 4001.25, "10th_percentile": 4001.25, "90th_percentile": 4001.25, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4426.23, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "FACTOR 5 LABILE", "code_information": [ { "code": "85220", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 277.9, "discounted_cash": 52.0, "minimum": 15.3555, "maximum": 222.32, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17.3, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.91 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 71.31 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 15.36 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.91 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 79.25 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 79.25 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 26.48, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 24.71, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 18.71, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 29.12, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 18.53, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26.4 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 34.86 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.53, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 31.43 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.91 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 32.88 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 29.12, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 17.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.18 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 17.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 17.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 28.88 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 26.48, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "DILATION & CURETTAGE FOR NON-OBSTETRIC DIAGNOSES - SOI : 3", "code_information": [ { "code": "5173", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 17729.83, "maximum": 18793.63, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 18469.72 } ] } ] }, { "description": "TIB/PER REVASC STENT & ATHER", "code_information": [ { "code": "37231", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 82011.6, "discounted_cash": 15582.0, "minimum": 7004.5304, "maximum": 65609.28, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7004.53, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 21200.16 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 11317.38 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 23591.16 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 23591.16 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10721.22, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 10006.47, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 7576.33, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11793.34, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 7504.85, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7504.85, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11793.34, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 7147.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7147.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 7147.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10721.22, "additional_payer_notes": "150.00% 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", "minimum": 31500.0, "maximum": 52542.0, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 42786.8 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 37017.32 } ] } ] }, { "description": "SOLU-MEDROL - 00009069801", "drug_information": { "unit": 1000.0, "type": "ME" }, "code_information": [ { "code": "00009069801", "type": "NDC" }, { "code": "J2919", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 75.0, "median_amount": 40.38, "10th_percentile": 36.48, "90th_percentile": 40.38, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 36.61, "10th_percentile": 27.24, "90th_percentile": 36.61, "count": "1 through 10" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 11.49, "10th_percentile": 9.69, "90th_percentile": 29.07, "count": "58" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 24.6, "median_amount": 7.95, "10th_percentile": 3.07, "90th_percentile": 8.83, "count": "27" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 10.23, "10th_percentile": 10.23, "90th_percentile": 18.48, "count": "26" } ] } ] }, { "description": "SCREW BONE 7.3 MM X 60MM X 16M", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "INITIAL TREATMENT OF BURN", "code_information": [ { "code": "16000", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 882.25, "discounted_cash": 165.0, "minimum": 79.9582, "maximum": 705.8, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 258.6 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 258.6 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 122.39, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 114.23, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 86.49, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 134.62, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 85.67, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.67, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 134.62, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 81.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 81.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 81.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 122.39, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 79.96, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 232.39 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 124.06 } ] } ] }, { "description": "BLUE RHINO TRACH INTRODUCER", "code_information": [ { "code": "C1769", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 228.66, "10th_percentile": 43.17, "90th_percentile": 1333.19, "count": "49" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 200.16, "10th_percentile": 45.57, "90th_percentile": 746.52, "count": "29" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 130.22, "10th_percentile": 39.18, "90th_percentile": 442.41, "count": "15" } ] } ] }, { "description": "SIGNS AND SYMPTOMS WITH MCC", "code_information": [ { "code": "947", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 5495.8818, "maximum": 27772.2, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 10758.7 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 12169.74 } ] } ] }, { "description": "CYSTIC FIBROSIS", "code_information": [ { "code": "81220", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 556.6, "discounted_cash": 105.0, "minimum": 83.49, "maximum": 923.3, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 545.47, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 556.6 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 556.6 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 484.24 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 556.6 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 556.6 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 556.6 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 556.6, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 556.6, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 556.6, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 556.6, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 556.6, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 556.6 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 556.6 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 556.6, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 556.6 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 556.6 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 556.6 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 556.6, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 556.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 556.6 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 556.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 556.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 556.6 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 556.6, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "XXL ESOPHAGEL BLN 16MMX6CM", "code_information": [ { "code": "C1725", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 462.76, "10th_percentile": 256.45, "90th_percentile": 2515.23, "count": "21" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 270.69, "10th_percentile": 106.59, "90th_percentile": 1342.29, "count": "14" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 484.0, "10th_percentile": 143.56, "90th_percentile": 543.74, "count": "1 through 10" } ] } ] }, { "description": "UMBILICAL CORD ART DOPPL", "code_information": [ { "code": "76820", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 448.0, "discounted_cash": 85.0, "minimum": 41.6598, "maximum": 448.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 41.66, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 135.95 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 448.0 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 97.51 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 135.95 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 448.0 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 448.0 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 63.77, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 59.51, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 45.06, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 70.14, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 44.64, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 144.11 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 190.28 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 44.64, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 171.59 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 135.95 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 179.51 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 70.14, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 42.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 131.99 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 42.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 42.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 108.06 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 63.77, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE O.R. PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "517", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 6449.9606, "maximum": 17263.8, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 15184.1 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 14732.34 } ] } ] }, { "description": "NEONATE BWT 1000-1249G W RESP DIST SYNDOTH MAJ RESP OR MAJ ANOM - SOI : 2", "code_information": [ { "code": "6022", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 86702.86, "maximum": 91905.03, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 90321.05 } ] } ] }, { "description": "CATH EV3 EVERCROSS 4X100MM", "code_information": [ { "code": "C1725", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 256.5, "10th_percentile": 256.5, "90th_percentile": 288.09, "count": "1 through 10" } ] } ] }, { "description": "MULTIPLE SCLEROSIS AND CEREBELLAR ATAXIA WITH CC", "code_information": [ { "code": "059", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 11359.0, "maximum": 27021.6, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 11359.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 11896.51 } ] } ] }, { "description": "DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH CC", "code_information": [ { "code": "439", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 3899.4392, "maximum": 22518.0, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 6517.12 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 8064.58 } ] } ] }, { "description": "RADIOTHERAPY - SOI : 3", "code_information": [ { "code": "6923", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 33065.45, "maximum": 35049.38, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 34445.3 } ] } ] }, { "description": "SMALL FRAG LCKNG SCREW 3.5X10", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "4.0MM CANNULATED SCREW - C1713 - 043841", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "SPLENIC PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "801", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 7774.403, "maximum": 18765.0, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 15583.5 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 18300.62 } ] } ] }, { "description": "OTHER FEMALE REPRODUCTIVE SYSTEM & RELATED PROCEDURES - SOI : 3", "code_information": [ { "code": "5183", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 28245.49, "maximum": 29940.22, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 29424.21 } ] } ] }, { "description": "BONE PASTE DBX PUTTY 5CC", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "PLATFORM HO CMTLSS FEMS8", "code_information": [ { "code": "C1776", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 4588.1, "10th_percentile": 1617.12, "90th_percentile": 11630.3, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 9120.0, "10th_percentile": 9120.0, "90th_percentile": 9120.0, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 8640.0, "10th_percentile": 8640.0, "90th_percentile": 9120.0, "count": "1 through 10" } ] } ] }, { "description": "POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROCEDURES WITH MCC", "code_information": [ { "code": "856", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 20992.0426, "maximum": 69055.2, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 31490.2 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 43608.39 } ] } ] }, { "description": "NON-HYPOVOLEMIC SODIUM DISORDERS - SOI : 1", "code_information": [ { "code": "4261", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 6189.45, "maximum": 6560.81, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 6447.74 } ] } ] }, { "description": "STENT ONYX FRONTIER 2.5X18MM", "code_information": [ { "code": "C1874", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 4258.8, "10th_percentile": 4258.8, "90th_percentile": 4420.0, "count": "1 through 10" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1456.46, "10th_percentile": 975.0, "90th_percentile": 4680.0, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1444.95, "10th_percentile": 1444.95, "90th_percentile": 1444.95, "count": "1 through 10" } ] } ] }, { "description": "SCREW SLF TPNG 2.7X28MM", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "CATHETER GUIDE 3 EBU 5FR", "code_information": [ { "code": "C1725", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 462.76, "10th_percentile": 256.45, "90th_percentile": 2515.23, "count": "21" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 270.69, "10th_percentile": 106.59, "90th_percentile": 1342.29, "count": "14" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 484.0, "10th_percentile": 143.56, "90th_percentile": 543.74, "count": "1 through 10" } ] } ] }, { "description": "3D MAX MESH XLARGE RIGHT", "code_information": [ { "code": "C1781", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1862.28, "10th_percentile": 1862.28, "90th_percentile": 11852.02, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1206.78, "10th_percentile": 1206.78, "90th_percentile": 1206.78, "count": "1 through 10" } ] } ] }, { "description": "SCRW SCR LT 65 6.5 COMPRESSION", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "CYTO FWB SMEAR & INTERP", "code_information": [ { "code": "88104", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 182.78, "discounted_cash": 34.0, "minimum": 14.8862, "maximum": 150.1, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14.89, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 135.06 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 29.08 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 150.1 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 150.1 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.79, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 21.27, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 16.1, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 25.06, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 15.95, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.95, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 25.06, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 15.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 15.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 15.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 23.81 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 22.79, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "Carpal tunnel surgery", "code_information": [ { "code": "64721", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2540.78, "discounted_cash": 482.0, "minimum": 381.117, "maximum": 2540.78, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 778.21, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 2286.74 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 1220.74 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 2540.78 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 2540.78 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1191.14, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 1111.73, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 841.74, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 2137.5, "10th_percentile": 2137.5, "90th_percentile": 2400.75, "count": "1 through 10" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1310.25, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 833.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 833.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 24.6, "median_amount": 1795.04, "10th_percentile": 1795.04, "90th_percentile": 1795.04, "count": "1 through 10" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 24.6, "median_amount": 1795.04, "10th_percentile": 1795.04, "90th_percentile": 1795.04, "count": "1 through 10" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1310.25, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 794.09, "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": 19.0, "median_amount": 2137.5, "10th_percentile": 2025.0, "90th_percentile": 2137.5, "count": "1 through 10" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 794.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 794.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "percent of total billed charges", "standard_charge_percentage": 54.8, "median_amount": 1458.2, "10th_percentile": 1458.2, "90th_percentile": 1458.2, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1191.14, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "MESH XENMATRIX 5.9X3.9 IN", "code_information": [ { "code": "C1781", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1862.28, "10th_percentile": 1862.28, "90th_percentile": 11852.02, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1206.78, "10th_percentile": 1206.78, "90th_percentile": 1206.78, "count": "1 through 10" } ] } ] }, { "description": "DISTAL BICEPS IMPLANT", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH CC", "code_information": [ { "code": "191", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 4078.1558, "maximum": 20266.2, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 6870.3 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 8081.84 } ] } ] }, { "description": "CULT CAMPY SCR", "code_information": [ { "code": "87081", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 128.0, "discounted_cash": 46.0, "minimum": 5.7681, "maximum": 195.2, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 75.0, "median_amount": 6.63, "10th_percentile": 6.63, "90th_percentile": 6.63, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.5, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.35 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 26.79 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5.77 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.35 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 29.77 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 29.77 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.95, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 9.28, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 7.03, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.94, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 6.96, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.91 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.09 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.96, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 11.8 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.35 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.35 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10.94, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 6.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.08 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 6.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 10.86 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9.95, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "HYDRATION IV INFUSION INIT (31 - 96360 - 007029", "code_information": [ { "code": "96360", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 998.59, "discounted_cash": 65.0, "minimum": 33.5472, "maximum": 798.872, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 75.0, "median_amount": 197.51, "10th_percentile": 197.51, "90th_percentile": 748.94, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 84.76, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 104.5 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 33.55 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 116.07 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 116.07 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 129.74, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 121.09, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 91.68, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 189.73, "10th_percentile": 179.75, "90th_percentile": 998.59, "count": "29" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 142.71, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 90.81, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 90.81, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 142.71, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 86.49, "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": 19.0, "median_amount": 189.73, "10th_percentile": 189.73, "90th_percentile": 189.73, "count": "18" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 86.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 86.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 189.73, "10th_percentile": 179.75, "90th_percentile": 213.1, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 129.74, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "Sho arthrs srg lmtd dbrdmt", "code_information": [ { "code": "29822", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5302.5, "discounted_cash": 1007.0, "minimum": 795.375, "maximum": 4242.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1303.98, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 3640.81 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 1943.59 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 4051.43 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 4051.43 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1995.89, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 1862.83, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 1410.43, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2195.47, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1397.12, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1397.12, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2195.47, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1330.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1330.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 1330.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1995.89, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "CALCIUM TOT", "code_information": [ { "code": "82310", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 106.25, "discounted_cash": 7.0, "minimum": 4.4892, "maximum": 85.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5.06, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.28 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 20.85 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 4.49 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.28 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 23.17 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 23.17 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7.74, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 7.22, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 5.47, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 22.67, "10th_percentile": 7.65, "90th_percentile": 47.32, "count": "1 through 10" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.51, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5.42, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.72 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.19 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.42, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 9.19 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.28 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.62 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.51, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.07 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 5.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 8.45 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.74, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "SEIZURES WITH MCC", "code_information": [ { "code": "100", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 8652.2848, "maximum": 33026.4, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 13611.5 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 18568.1 } ] } ] }, { "description": "TREAT SHOULDER DISLOCATION - 23655 - 007075", "code_information": [ { "code": "23655", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3510.0, "discounted_cash": 335.0, "minimum": 265.125, "maximum": 2808.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 640.82, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 1802.67 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 962.33 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 2005.98 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 2005.98 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 980.85, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 915.46, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 693.13, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1078.94, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 686.6, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 686.6, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1078.94, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 653.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 653.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 653.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 980.85, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "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", "minimum": 17550.0, "maximum": 37503.3853, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 33335.6 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 37503.39 } ] } ] }, { "description": "CONTROL OF NOSEBLEED", "code_information": [ { "code": "30905", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 758.75, "discounted_cash": 104.0, "minimum": 53.018, "maximum": 607.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 53.02, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 145.01 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 77.41 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 161.36 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 161.36 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 307.89, "10th_percentile": 307.89, "90th_percentile": 307.89, "count": "1 through 10" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 81.15, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 75.74, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 57.35, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 89.27, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 56.81, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 56.81, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 89.27, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 54.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 54.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 54.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "percent of total billed charges", "standard_charge_percentage": 54.8, "median_amount": 117.33, "10th_percentile": 117.33, "90th_percentile": 117.33, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 81.15, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITH MCC", "code_information": [ { "code": "094", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 28218.3, "maximum": 59297.4, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 28218.3 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 33740.49 } ] } ] }, { "description": "ALLERGIC REACTIONS - SOI : 4", "code_information": [ { "code": "8114", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 20976.88, "maximum": 22235.5, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 21852.27 } ] } ] }, { "description": "OTHER PNEUMONIA - SOI : 1", "code_information": [ { "code": "1391", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 4712.99, "maximum": 4995.77, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 4909.67 } ] } ] }, { "description": "SEMEN ANALYSIS COMPLETE", "code_information": [ { "code": "89320", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 208.63, "discounted_cash": 39.0, "minimum": 10.7097, "maximum": 166.904, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12.06, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 49.73 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 10.71 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 55.27 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 55.27 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.47, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 17.23, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 13.05, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 20.31, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.93, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.93, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.31, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 12.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 19.73 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.47, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "STENT COR 18MM 2.5MM COCR", "code_information": [ { "code": "C1876", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 3100.8, "10th_percentile": 1880.29, "90th_percentile": 7522.24, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 3482.69, "10th_percentile": 3482.69, "90th_percentile": 3482.69, "count": "1 through 10" } ] } ] }, { "description": "QUELICIN", "drug_information": { "unit": 10.0, "type": "ML" }, "code_information": [ { "code": "00409662902", "type": "NDC" }, { "code": "J0330", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 27.2, "10th_percentile": 27.2, "90th_percentile": 27.2, "count": "1 through 10" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 8.54, "10th_percentile": 8.54, "90th_percentile": 8.54, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 7.6, "10th_percentile": 7.6, "90th_percentile": 7.6, "count": "1 through 10" } ] } ] }, { "description": "MESH PHASIX ST SURGICAL 20X25C", "code_information": [ { "code": "C1781", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1862.28, "10th_percentile": 1862.28, "90th_percentile": 11852.02, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1206.78, "10th_percentile": 1206.78, "90th_percentile": 1206.78, "count": "1 through 10" } ] } ] }, { "description": "RPR NON&TUNL CTR VAD CATH WOPP", "code_information": [ { "code": "36575", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2166.0, "discounted_cash": 411.0, "minimum": 249.9882, "maximum": 1732.8, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 249.99, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 838.58 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 447.66 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 933.15 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 933.15 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 382.64, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 357.13, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 270.4, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 420.9, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 267.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 267.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 420.9, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 255.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 255.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 255.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 382.64, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "STENT RESOLUTE ONYX 2.0X18MM", "code_information": [ { "code": "C1874", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 4258.8, "10th_percentile": 4258.8, "90th_percentile": 4420.0, "count": "1 through 10" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1456.46, "10th_percentile": 975.0, "90th_percentile": 4680.0, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1444.95, "10th_percentile": 1444.95, "90th_percentile": 1444.95, "count": "1 through 10" } ] } ] }, { "description": "NAIL TFN LONG 11 MM X 380", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "MRI RT LOWER EXT NON JNT W/WO", "code_information": [ { "code": "73720", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5647.13, "discounted_cash": 1072.0, "minimum": 139.0326, "maximum": 4517.704, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 139.03, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 475.54 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 1542.67 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 332.21 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 475.54 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1714.51 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 1714.51 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 3840.05, "10th_percentile": 3840.05, "90th_percentile": 3840.05, "count": "1 through 10" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 212.81, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 198.62, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 150.38, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 234.09, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 148.96, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 504.07 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 665.57 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 148.96, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 600.2 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 475.54 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 627.9 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 234.09, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 141.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 461.69 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 141.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 141.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 591.5 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 212.81, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "IONIZED CA", "code_information": [ { "code": "82330", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 75.24, "discounted_cash": 14.0, "minimum": 11.286, "maximum": 61.42, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13.41, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.3 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 55.27 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 11.9 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.3 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 61.42 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 61.42 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 20.52, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 19.15, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 14.5, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 22.57, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 14.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.46 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.02 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 24.36 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.3 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.49 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 22.57, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 13.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.74 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 13.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 22.38 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 20.52, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "CMV IGG QUAL", "code_information": [ { "code": "86644", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 257.5, "discounted_cash": 48.0, "minimum": 12.5193, "maximum": 206.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14.1, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.3 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 58.14 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.52 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.3 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 64.61 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 64.61 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 21.59, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 20.15, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 15.25, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 23.74, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 15.11, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.52 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28.41 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.11, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 25.62 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.3 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26.81 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 23.74, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 14.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.71 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 14.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 23.57 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.59, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "PREG URINE QUAL - 81025 - 408021", "code_information": [ { "code": "81025", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8.84, "discounted_cash": 1.0, "minimum": 1.326, "maximum": 183.704, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.44, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.84 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 8.84 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 7.49 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.84 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 8.84 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 8.84 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.84, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 8.84, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 8.84, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.84, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 8.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.84 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.84 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 8.84 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.84 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.84 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.84, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 8.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.84 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 8.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 8.84 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.84, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "STENT XIENCE SIERA 3.0X28", "code_information": [ { "code": "C1874", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 4258.8, "10th_percentile": 4258.8, "90th_percentile": 4420.0, "count": "1 through 10" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1456.46, "10th_percentile": 975.0, "90th_percentile": 4680.0, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1444.95, "10th_percentile": 1444.95, "90th_percentile": 1444.95, "count": "1 through 10" } ] } ] }, { "description": "PLATE 90X11X3.3MM SS 3.5MM SCR", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "SCREW 7X25MM", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "HIV WITH OR WITHOUT OTHER RELATED CONDITION", "code_information": [ { "code": "977", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 6099.4544, "maximum": 27021.6, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 13686.7 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 12441.05 } ] } ] }, { "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", "minimum": 17315.191, "maximum": 56295.0, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 49876.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 34183.41 } ] } ] }, { "description": "STENT RESOLUTE ONYX 2.5X15MM", "code_information": [ { "code": "C1874", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 4258.8, "10th_percentile": 4258.8, "90th_percentile": 4420.0, "count": "1 through 10" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1456.46, "10th_percentile": 975.0, "90th_percentile": 4680.0, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1444.95, "10th_percentile": 1444.95, "90th_percentile": 1444.95, "count": "1 through 10" } ] } ] }, { "description": "BIPAP INIT", "code_information": [ { "code": "94660", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 758.17, "discounted_cash": 1185.0, "minimum": 87.2592, "maximum": 4992.904, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 87.26, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 498.53 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 160.05 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 553.72 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 553.72 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 133.56, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 124.66, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 94.38, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1123.4, "10th_percentile": 904.96, "90th_percentile": 1210.78, "count": "1 through 10" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 146.92, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 93.49, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 93.49, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 24.6, "median_amount": 3395.19, "10th_percentile": 3395.19, "90th_percentile": 3395.19, "count": "1 through 10" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 146.92, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 89.04, "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": 19.0, "median_amount": 1185.81, "10th_percentile": 1185.81, "90th_percentile": 1185.81, "count": "1 through 10" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 89.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 89.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 168.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 133.56, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "SCREW BONE 5MMX4.4MMX48MM", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "PACEMAKER INSIGNIA DUAL", "code_information": [ { "code": "C1785", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 6147.84, "10th_percentile": 6147.84, "90th_percentile": 6147.84, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 6147.84, "10th_percentile": 6147.84, "90th_percentile": 6147.84, "count": "1 through 10" } ] } ] }, { "description": "FLUOROSCOPY DX/INTERVENT", "code_information": [ { "code": "76496", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 330.0, "discounted_cash": 62.0, "minimum": 34.6822, "maximum": 330.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 34.68, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 112.36 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 322.43 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 69.43 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 112.36 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 330.0 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 330.0 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 53.09, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 49.55, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 37.51, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 58.39, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 37.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 119.1 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 157.26 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 37.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 141.82 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 112.36 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 148.36 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 58.39, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 35.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 109.09 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 35.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 35.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 188.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 53.09, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "UTERINE & ADNEXA PROCEDURES FOR NON-MALIGNANCY EXCEPT LEIOMYOMA - SOI : 1", "code_information": [ { "code": "5131", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 10230.11, "maximum": 10843.92, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 10657.02 } ] } ] }, { "description": "SCREW CAPTURED GOLD 5X55", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "FIXED TIBIAL TRAY LEFT SZ 3", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "Partial removal of toe", "code_information": [ { "code": "28124", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2651.25, "discounted_cash": 503.0, "minimum": 214.21, "maximum": 2195.4735, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1303.98, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 289.64 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 214.21 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 322.83 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 322.83 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1995.89, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 1862.83, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 1410.43, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2195.47, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1397.12, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1397.12, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2195.47, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1330.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1330.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 1330.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1995.89, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "STENT ONYX FRONTIER 3.5X30MM", "code_information": [ { "code": "C1874", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 4258.8, "10th_percentile": 4258.8, "90th_percentile": 4420.0, "count": "1 through 10" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1456.46, "10th_percentile": 975.0, "90th_percentile": 4680.0, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1444.95, "10th_percentile": 1444.95, "90th_percentile": 1444.95, "count": "1 through 10" } ] } ] }, { "description": "XR NASAL BONES COMP", "code_information": [ { "code": "70160", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 492.43, "discounted_cash": 93.0, "minimum": 34.6822, "maximum": 393.944, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 34.68, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 112.36 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 322.43 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 69.43 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 112.36 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 358.35 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 358.35 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 53.09, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 49.55, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 37.51, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 58.39, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 37.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 119.1 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 157.26 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 37.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "QTC Medical Group", "plan_name": "QTC Medical Group", "methodology": "fee schedule", "standard_charge_dollar": 51.82 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 141.82 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 112.36 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 148.36 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 58.39, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 35.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 109.09 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 35.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 35.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 68.82 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 53.09, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "OTHER EAR, NOSE, MOUTH AND THROAT DIAGNOSES WITHOUT CCMCC", "code_information": [ { "code": "156", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 3036.7968, "maximum": 15762.6, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 3842.2 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 6625.58 } ] } ] }, { "description": "MRI CHEST W/WO", "code_information": [ { "code": "71552", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5143.0, "discounted_cash": 977.0, "minimum": 139.0326, "maximum": 4114.4, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 139.03, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 475.54 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 1542.67 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 332.21 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 475.54 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1714.51 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 1714.51 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 212.81, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 198.62, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 150.38, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 234.09, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 148.96, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 504.07 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 665.57 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 148.96, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 600.2 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 475.54 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 627.9 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 234.09, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 141.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 461.69 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 141.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 141.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 591.5 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 212.81, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "PT NPWT <50CM 45MIN - 97605 - 972002", "code_information": [ { "code": "97605", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1035.93, "discounted_cash": 77.0, "minimum": 45.315, "maximum": 900.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 79.96, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 473.52 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 152.02 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 525.94 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 525.94 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 122.39, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 114.23, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 86.49, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 1895.25, "10th_percentile": 731.62, "90th_percentile": 2268.2, "count": "1 through 10" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 196.83, "10th_percentile": 108.48, "90th_percentile": 663.21, "count": "22" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 134.62, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 85.67, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.67, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 134.62, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 81.59, "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": 19.0, "median_amount": 196.83, "10th_percentile": 196.83, "90th_percentile": 196.83, "count": "1 through 10" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 81.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 81.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 186.47, "10th_percentile": 106.25, "90th_percentile": 196.83, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 122.39, "additional_payer_notes": "150.00% 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", "minimum": 16552.2974, "maximum": 40532.4, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 28179.9 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 35829.5 } ] } ] }, { "description": "SKIN DEBRIDEMENT WITH CC", "code_information": [ { "code": "571", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 7540.2704, "maximum": 36779.4, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 15273.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 16197.24 } ] } ] }, { "description": "Canalith Reposition", "code_information": [ { "code": "95992", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 236.5, "discounted_cash": 44.0, "minimum": 28.8316, "maximum": 189.2, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 28.83, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 104.5 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 33.55 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 116.07 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 116.07 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 44.13, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 41.19, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 31.19, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 48.54, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 30.89, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30.89, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 48.54, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 29.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 29.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 29.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 79.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 44.13, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "CARDIAC PACEMAKER & DEFIBRILLATOR REVISION EXCEPT DEVICE REPLACEMENT - SOI : 2", "code_information": [ { "code": "1772", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 23625.14, "maximum": 25042.64, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 24611.04 } ] } ] }, { "description": "CARDIAC DEFIBRILLATOR IMPLANT WITH MCC", "code_information": [ { "code": "276", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 27900.0, "maximum": 57585.2742, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 32217.9 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 57585.27 } ] } ] }, { "description": "BACTERIAL & TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM - SOI : 3", "code_information": [ { "code": "0493", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 29603.52, "maximum": 31379.74, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 30838.91 } ] } ] }, { "description": "MISCELLANEOUS DISORDERS OF NUTRITION, METABOLISM, FLUIDS AND ELECTROLYTES WITHOUT MCC", "code_information": [ { "code": "641", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 3477.354, "maximum": 19515.6, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 5357.54 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 7460.6 } ] } ] }, { "description": "KIDNEY TRANSPLANT - SOI : 1", "code_information": [ { "code": "4401", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 58316.97, "maximum": 61815.99, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 60750.6 } ] } ] }, { "description": "CATH 6F INFINITI TL JR4", "code_information": [ { "code": "C1887", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 115.24, "10th_percentile": 81.0, "90th_percentile": 503.66, "count": "23" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 156.51, "10th_percentile": 102.6, "90th_percentile": 572.45, "count": "11" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 129.36, "10th_percentile": 24.35, "90th_percentile": 512.12, "count": "1 through 10" } ] } ] }, { "description": "GAMMA NAIL SCREW 6.28X50", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "OTHER INFECTIOUS & PARASITIC DISEASES - SOI : 1", "code_information": [ { "code": "7241", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 6221.92, "maximum": 6595.23, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 6481.56 } ] } ] }, { "description": "BX MUSCLE NEEDLE PERC", "code_information": [ { "code": "20206", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4126.5, "discounted_cash": 1303.0, "minimum": 618.975, "maximum": 5490.4, "payers_information": [ { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1108.19, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 671.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 671.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 671.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1007.45, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 658.2, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 1825.56 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 974.55 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 2031.45 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 2031.45 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1007.45, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 940.28, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 711.93, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1108.19, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 705.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 705.21, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "MOD.BARIUM 120MIN", "code_information": [ { "code": "92611", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 583.0, "discounted_cash": 138.0, "minimum": 78.4995, "maximum": 641.304, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 87.23, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 249.05 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 79.95 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 276.62 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 276.62 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 408.1, "10th_percentile": 408.1, "90th_percentile": 408.1, "count": "1 through 10" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 133.52, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 124.61, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 94.35, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 218.63, "10th_percentile": 218.63, "90th_percentile": 240.49, "count": "1 through 10" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 155.52, "10th_percentile": 18.44, "90th_percentile": 171.07, "count": "1 through 10" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 146.87, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 93.46, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 93.46, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 24.6, "median_amount": 198.48, "10th_percentile": 198.48, "90th_percentile": 198.48, "count": "1 through 10" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 146.87, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 89.01, "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": 19.0, "median_amount": 152.31, "10th_percentile": 138.46, "90th_percentile": 152.31, "count": "1 through 10" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 89.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 89.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 155.52, "10th_percentile": 144.29, "90th_percentile": 155.52, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 79.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 133.52, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "VOLAR DISTAL RAD PLT TI W RT 5", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "CHROMOGRANIN A", "code_information": [ { "code": "86316", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 140.0, "discounted_cash": 23.0, "minimum": 18.1047, "maximum": 112.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 20.39, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 29.37 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 84.07 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 18.1 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 29.37 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 93.44 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 93.44 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 31.22, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 29.13, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 22.06, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 34.34, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 21.85, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.13 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 41.1 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.85, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 37.06 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 29.37 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 38.77 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 34.34, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28.51 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 34.07 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 31.22, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "Cryptosporidium EIA", "code_information": [ { "code": "87329", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 57.87, "discounted_cash": 10.0, "minimum": 8.6805, "maximum": 53.79, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11.74, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.9 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 48.4 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 10.42 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.9 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 53.79 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 53.79 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17.97, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 12.7, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.77, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.92 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.66 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 21.33 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.9 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.32 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.77, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.41 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 19.63 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.97, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "CREATININE OTHER", "code_information": [ { "code": "82570", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 117.5, "discounted_cash": 22.0, "minimum": 4.5066, "maximum": 147.4, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 75.0, "median_amount": 138.19, "10th_percentile": 138.19, "90th_percentile": 138.19, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5.08, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.31 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 20.93 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 4.51 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.31 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 23.26 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 23.26 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 125.29, "10th_percentile": 103.18, "90th_percentile": 125.29, "count": "1 through 10" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7.77, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 7.25, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 5.49, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 35.01, "10th_percentile": 33.17, "90th_percentile": 39.32, "count": "48" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.55, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5.44, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.75 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.24 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.44, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 9.23 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.31 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.66 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.55, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.1 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 35.01, "10th_percentile": 35.01, "90th_percentile": 35.01, "count": "29" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 35.74, "10th_percentile": 33.17, "90th_percentile": 39.32, "count": "15" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 8.47 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.77, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "SCREW 2.7MM X 55MM CORTEX ST", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "Removal of breast lesion", "code_information": [ { "code": "19120", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4418.75, "discounted_cash": 839.0, "minimum": 662.8125, "maximum": 4418.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1560.41, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 4029.3 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 2150.98 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 4418.75 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 4418.75 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2388.38, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 2229.15, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 1687.79, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2627.21, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1671.86, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1671.86, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2627.21, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1592.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1592.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 1592.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2388.38, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "OTHER FEMALE REPRODUCTIVE SYSTEM O.R. PROCEDURES WITH CCMCC", "code_information": [ { "code": "749", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 12502.7732, "maximum": 39781.8, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 15063.5 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 24615.58 } ] } ] }, { "description": "HERNIA PROCEDURES EXCEPT INGUINAL, FEMORAL & UMBILICAL - SOI : 2", "code_information": [ { "code": "2272", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 17963.81, "maximum": 19041.64, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 18713.46 } ] } ] }, { "description": "PLEURAL EFFUSION WITH CC", "code_information": [ { "code": "187", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 4766.6996, "maximum": 22518.0, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 7612.58 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 9482.5 } ] } ] }, { "description": "CATH POWERCROSS BALLOON 5X200", "code_information": [ { "code": "C1725", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 462.76, "10th_percentile": 256.45, "90th_percentile": 2515.23, "count": "21" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 270.69, "10th_percentile": 106.59, "90th_percentile": 1342.29, "count": "14" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 484.0, "10th_percentile": 143.56, "90th_percentile": 543.74, "count": "1 through 10" } ] } ] }, { "description": "EXT FIX SM ROD 300MM", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "ANAL AND STOMAL PROCEDURES WITH CC", "code_information": [ { "code": "348", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 6199.2032, "maximum": 23268.6, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 11491.5 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 12547.47 } ] } ] }, { "description": "FEMORAL COMPONENT RIGHT SZ2+", "code_information": [ { "code": "C1776", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 4588.1, "10th_percentile": 1617.12, "90th_percentile": 11630.3, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 9120.0, "10th_percentile": 9120.0, "90th_percentile": 9120.0, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 8640.0, "10th_percentile": 8640.0, "90th_percentile": 9120.0, "count": "1 through 10" } ] } ] }, { "description": "Njx interlaminar lmbrsac", "code_information": [ { "code": "62323", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5334.38, "discounted_cash": 1013.0, "minimum": 281.309, "maximum": 4267.504, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 281.31, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 831.32 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 443.79 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 925.07 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 925.07 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 430.58, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 401.87, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 304.27, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 473.63, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 301.4, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 301.4, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 473.63, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 287.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 287.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 287.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 430.58, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "RUSH BONE PIN 802-01-02 - C1713 - 052063", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "CATH BALLOON LEGEND RX 2.5X20M", "code_information": [ { "code": "C1725", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 462.76, "10th_percentile": 256.45, "90th_percentile": 2515.23, "count": "21" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 270.69, "10th_percentile": 106.59, "90th_percentile": 1342.29, "count": "14" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 484.0, "10th_percentile": 143.56, "90th_percentile": 543.74, "count": "1 through 10" } ] } ] }, { "description": "CRYSTALS, SYNOVIAL/JOINT FLUID", "code_information": [ { "code": "89060", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 40.75, "discounted_cash": 23.0, "minimum": 6.1125, "maximum": 98.4, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7.18, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.34 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 29.61 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 6.38 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.34 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 32.91 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 32.91 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 83.64, "10th_percentile": 83.64, "90th_percentile": 83.64, "count": "1 through 10" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11.0, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 10.26, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 7.77, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 7.7, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.96 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.47 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.7, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 13.05 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.34 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.65 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 7.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.04 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 7.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 11.71 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11.0, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "COCAINE ABUSE & DEPENDENCE - SOI : 2", "code_information": [ { "code": "7742", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 5342.35, "maximum": 5662.89, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 5565.29 } ] } ] }, { "description": "FEMORAL COMPONENT LEFT SZ 6", "code_information": [ { "code": "C1776", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 4588.1, "10th_percentile": 1617.12, "90th_percentile": 11630.3, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 9120.0, "10th_percentile": 9120.0, "90th_percentile": 9120.0, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 8640.0, "10th_percentile": 8640.0, "90th_percentile": 9120.0, "count": "1 through 10" } ] } ] }, { "description": "MRI LOWER EXT JOINT-LT", "code_information": [ { "code": "73721", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3199.0, "discounted_cash": 954.0, "minimum": 95.0796, "maximum": 4020.2, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 95.08, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 303.0 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 941.48 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 202.74 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 303.0 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1046.35 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 1046.35 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 1791.44, "10th_percentile": 1791.44, "90th_percentile": 2945.25, "count": "1 through 10" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 145.53, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 135.83, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 102.84, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 959.7, "10th_percentile": 959.7, "90th_percentile": 1299.38, "count": "21" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 607.81, "10th_percentile": 98.09, "90th_percentile": 682.67, "count": "1 through 10" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 160.08, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 101.87, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 321.17 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 424.08 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 101.87, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 382.42 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 303.0 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 400.07 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 160.08, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 97.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 294.17 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 607.81, "10th_percentile": 607.81, "90th_percentile": 607.81, "count": "1 through 10" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 97.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 97.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 840.26, "10th_percentile": 575.82, "90th_percentile": 924.29, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 353.74 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 145.53, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "STENT XIENCE ALPINE 3.25X23", "code_information": [ { "code": "C1876", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 3100.8, "10th_percentile": 1880.29, "90th_percentile": 7522.24, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 3482.69, "10th_percentile": 3482.69, "90th_percentile": 3482.69, "count": "1 through 10" } ] } ] }, { "description": "RADIAL STEM CURVED 6MMX40MM", "code_information": [ { "code": "C1776", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 4588.1, "10th_percentile": 1617.12, "90th_percentile": 11630.3, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 9120.0, "10th_percentile": 9120.0, "90th_percentile": 9120.0, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 8640.0, "10th_percentile": 8640.0, "90th_percentile": 9120.0, "count": "1 through 10" } ] } ] }, { "description": "TIBIAL INSERT FIXED SZ 5 RIGHT", "code_information": [ { "code": "C1776", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 4588.1, "10th_percentile": 1617.12, "90th_percentile": 11630.3, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 9120.0, "10th_percentile": 9120.0, "90th_percentile": 9120.0, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 8640.0, "10th_percentile": 8640.0, "90th_percentile": 9120.0, "count": "1 through 10" } ] } ] }, { "description": "OTHER HEPATOBILIARY, PANCREAS & ABDOMINAL PROCEDURES - SOI : 3", "code_information": [ { "code": "2643", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 35436.75, "maximum": 37562.95, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 36915.56 } ] } ] }, { "description": "DRILL BIT 16MM CANNULATED", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 168.56, "10th_percentile": 168.56, "90th_percentile": 168.56, "count": "1 through 10" } ] } ] }, { "description": "NEONATE BIRTHWT 1500-1999G W CONGENITALPERINATAL INFECTION - SOI : 3", "code_information": [ { "code": "6133", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 49833.59, "maximum": 52823.6, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 51913.19 } ] } ] }, { "description": "IMM ADMIN 1VACC IM/SUBQ", "code_information": [ { "code": "90471", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 174.6, "discounted_cash": 12.0, "minimum": 10.119, "maximum": 269.856, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 28.69, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 163.87 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 52.61 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 174.6 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 174.6 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 43.92, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 40.99, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 31.04, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 48.31, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 30.74, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30.74, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 48.31, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 29.28, "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": 24.6, "median_amount": 15.25, "10th_percentile": 15.25, "90th_percentile": 67.46, "count": "1 through 10" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 29.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 29.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 43.92, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "ELECTRODE COOLPULSEE90", "code_information": [ { "code": "A4649", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 10.66, "10th_percentile": 3.56, "90th_percentile": 309.79, "count": "12" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 9.49, "10th_percentile": 3.56, "90th_percentile": 336.36, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 9.49, "10th_percentile": 8.78, "90th_percentile": 73.99, "count": "1 through 10" } ] } ] }, { "description": "SUT ETHILON 5-0 698H", "code_information": [ { "code": "A4649", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 10.66, "10th_percentile": 3.56, "90th_percentile": 309.79, "count": "12" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 9.49, "10th_percentile": 3.56, "90th_percentile": 336.36, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 9.49, "10th_percentile": 8.78, "90th_percentile": 73.99, "count": "1 through 10" } ] } ] }, { "description": "CATH NANOCROSS ELITE BLN 6X80M", "code_information": [ { "code": "C1725", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 462.76, "10th_percentile": 256.45, "90th_percentile": 2515.23, "count": "21" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 270.69, "10th_percentile": 106.59, "90th_percentile": 1342.29, "count": "14" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 484.0, "10th_percentile": 143.56, "90th_percentile": 543.74, "count": "1 through 10" } ] } ] }, { "description": "ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITHOUT CCMCC", "code_information": [ { "code": "063", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 9900.0, "maximum": 16513.2, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 11632.7 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 13458.23 } ] } ] }, { "description": "MAM DIAGNOSTIC RT W/ICAD", "code_information": [ { "code": "77065", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1293.1, "discounted_cash": 62.0, "minimum": 49.626, "maximum": 1034.48, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 80.12, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 380.0 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 81.83 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 422.33 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 422.33 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 122.64, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 114.46, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 86.67, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 134.9, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 85.85, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.85, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 134.9, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 81.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 81.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 81.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 113.05 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 122.64, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "MAJOR RESPIRATORY INFECTIONS & INFLAMMATIONS - SOI : 3", "code_information": [ { "code": "1373", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 16085.3, "maximum": 17050.42, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 16756.56 } ] } ] }, { "description": "BIOSYN SUPPORT ANTERIOR", "code_information": [ { "code": "C1781", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1862.28, "10th_percentile": 1862.28, "90th_percentile": 11852.02, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1206.78, "10th_percentile": 1206.78, "90th_percentile": 1206.78, "count": "1 through 10" } ] } ] }, { "description": "SCREW CORTICLE 4.5X42M", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "Ankle arthroscopy/surgery", "code_information": [ { "code": "29895", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6186.25, "discounted_cash": 1175.0, "minimum": 927.9375, "maximum": 4949.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1303.98, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 3640.81 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 1943.59 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 4051.43 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 4051.43 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1995.89, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 1862.83, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 1410.43, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2195.47, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1397.12, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1397.12, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2195.47, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1330.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1330.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 1330.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1995.89, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "OSTEOMYELITIS, SEPTIC ARTHRITIS & OTHER MUSCULOSKELETAL INFECTIONS - SOI : 3", "code_information": [ { "code": "3443", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 15759.64, "maximum": 16705.22, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 16417.31 } ] } ] }, { "description": "STENT DELIVERY SYSTEM 2.5X18", "code_information": [ { "code": "C1876", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 3100.8, "10th_percentile": 1880.29, "90th_percentile": 7522.24, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 3482.69, "10th_percentile": 3482.69, "90th_percentile": 3482.69, "count": "1 through 10" } ] } ] }, { "description": "EAR, NOSE, MOUTH AND THROAT MALIGNANCY WITH MCC", "code_information": [ { "code": "146", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 9388.8558, "maximum": 44285.4, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 12189.4 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 20299.51 } ] } ] }, { "description": "DRAINAGE OF SKIN ABSCESS - 10060 - 034806", "code_information": [ { "code": "10060", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 941.76, "discounted_cash": 178.0, "minimum": 53.56, "maximum": 753.408, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 79.96, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 72.41 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 53.56 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 80.71 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 80.71 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 640.4, "10th_percentile": 640.4, "90th_percentile": 640.4, "count": "1 through 10" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 122.39, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 114.23, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 86.49, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 181.97, "10th_percentile": 181.97, "90th_percentile": 412.39, "count": "1 through 10" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 134.62, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 85.67, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.67, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 24.6, "median_amount": 67.01, "10th_percentile": 67.01, "90th_percentile": 67.01, "count": "1 through 10" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 134.62, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 81.59, "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": 19.0, "median_amount": 178.93, "10th_percentile": 178.93, "90th_percentile": 178.93, "count": "1 through 10" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 81.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 81.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 122.39, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "SEPTIC ARTHRITIS WITHOUT CCMCC", "code_information": [ { "code": "550", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 4076.3086, "maximum": 21767.4, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 6381.15 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 8380.0 } ] } ] }, { "description": "UNITE POROCOAT STNDRD STEM 14", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "VITAMIN E", "code_information": [ { "code": "84446", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 140.8, "discounted_cash": 26.0, "minimum": 12.3366, "maximum": 112.64, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13.9, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.01 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 57.29 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.34 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.01 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 63.67 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 63.67 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 78.85, "10th_percentile": 78.85, "90th_percentile": 78.85, "count": "1 through 10" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 21.27, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 19.85, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 15.03, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 23.4, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 14.89, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.21 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28.01 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.89, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 25.26 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.01 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26.42 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 23.4, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "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": "fee schedule", "standard_charge_dollar": 19.43 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 14.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 23.21 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.27, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "STENT XIENCE ALPINE 2.5X33MM", "code_information": [ { "code": "C1874", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 4258.8, "10th_percentile": 4258.8, "90th_percentile": 4420.0, "count": "1 through 10" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1456.46, "10th_percentile": 975.0, "90th_percentile": 4680.0, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1444.95, "10th_percentile": 1444.95, "90th_percentile": 1444.95, "count": "1 through 10" } ] } ] }, { "description": "OTHER SKIN, SUBCUTANEOUS TISSUE AND BREAST PROCEDURES WITH CC", "code_information": [ { "code": "580", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 7390.1854, "maximum": 31525.2, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 18969.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 16566.34 } ] } ] }, { "description": "GTT 4 HR SERUM", "code_information": [ { "code": "82952", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 83.75, "discounted_cash": 16.0, "minimum": 3.4104, "maximum": 70.4, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3.84, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.53 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 15.84 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3.41 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.53 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 17.6 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 17.6 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5.88, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 5.49, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 4.16, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 4.12, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.86 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.74 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.12, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 6.98 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.53 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.3 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "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": "fee schedule", "standard_charge_dollar": 5.37 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 3.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 6.42 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5.88, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "SCREW CANN COMP HDLESS 3.5 TI", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "SLP TREATMENT GROUP 30MIN", "code_information": [ { "code": "92508", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 341.25, "discounted_cash": 64.0, "minimum": 21.0105, "maximum": 273.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.9, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 65.45 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 21.01 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 72.69 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 72.69 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 35.06, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 32.72, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 24.77, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 38.56, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 24.54, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.54, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 38.56, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 23.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 23.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 23.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 79.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 35.06, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "DORSAL & LUMBAR FUSION PROC FOR CURVATURE OF BACK - SOI : 1", "code_information": [ { "code": "3031", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 57585.43, "maximum": 61040.56, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 59988.53 } ] } ] }, { "description": "INSRT PICVAD TUNNELLED W/PORT", "code_information": [ { "code": "36571", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7666.35, "discounted_cash": 1456.0, "minimum": 1149.9525, "maximum": 6133.08, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1258.34, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 3685.8 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 1967.61 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 4101.49 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 4101.49 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1926.03, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 1797.63, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 1361.06, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2118.63, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1348.22, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1348.22, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2118.63, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1284.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1284.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 1284.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1926.03, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "NAIL TFN SYSTEM LONG 11 MM", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "GUIDEWIRE SS L260CM L3MM", "code_information": [ { "code": "C1769", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 228.66, "10th_percentile": 43.17, "90th_percentile": 1333.19, "count": "49" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 200.16, "10th_percentile": 45.57, "90th_percentile": 746.52, "count": "29" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 130.22, "10th_percentile": 39.18, "90th_percentile": 442.41, "count": "15" } ] } ] }, { "description": "EXTERNAL HEART ASSIST SYSTEMS- SOI : 4", "code_information": [ { "code": "1784", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 140079.54, "maximum": 148484.32, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 145925.2 } ] } ] }, { "description": "BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITH CC", "code_information": [ { "code": "519", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 9040.6586, "maximum": 24019.2, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 19057.1 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 19175.92 } ] } ] }, { "description": "THYROID, PARATHYROID & THYROGLOSSAL PROCEDURES - SOI : 2", "code_information": [ { "code": "4042", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 20861.33, "maximum": 22113.01, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 21731.89 } ] } ] }, { "description": "PERCUTANEOUS AND OTHER INTRACARDIAC PROCEDURES WITH MCC", "code_information": [ { "code": "273", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 15300.0, "maximum": 42785.9, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 42785.9 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 39551.17 } ] } ] }, { "description": "VALPROIC ACID (DEPAKENE) FREE", "code_information": [ { "code": "80165", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 67.7, "discounted_cash": 15.0, "minimum": 10.155, "maximum": 65.96, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13.27, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.11 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 54.7 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 11.78 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.11 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 60.79 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 60.79 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 20.31, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 18.96, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 14.35, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 22.34, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 14.22, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.25 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26.74 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.22, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 24.12 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.11 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.23 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 22.34, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "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": "fee schedule", "standard_charge_dollar": 18.55 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 13.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 22.13 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 20.31, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "CORTEX SCREW 3.5MM 45MM", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "STENT ONYX FRONTIER 2.25X38MM", "code_information": [ { "code": "C1874", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 4258.8, "10th_percentile": 4258.8, "90th_percentile": 4420.0, "count": "1 through 10" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1456.46, "10th_percentile": 975.0, "90th_percentile": 4680.0, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1444.95, "10th_percentile": 1444.95, "90th_percentile": 1444.95, "count": "1 through 10" } ] } ] }, { "description": "GC DNA SDA - 87591 - 843464", "code_information": [ { "code": "87591", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 251.52, "discounted_cash": 6.0, "minimum": 5.2635, "maximum": 201.216, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 34.39, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 49.51 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 141.76 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 30.53 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 49.51 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 157.55 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 157.55 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 140.85, "10th_percentile": 140.85, "90th_percentile": 140.85, "count": "1 through 10" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 52.64, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 49.13, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 37.2, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 57.9, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 36.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 52.48 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 69.3 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 62.49 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 49.51 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 65.38 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 57.9, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 48.07 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 57.44 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 52.64, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "REMOVAL OF SKIN TAGS UP TO 15", "code_information": [ { "code": "11200", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 882.25, "discounted_cash": 251.0, "minimum": 79.9582, "maximum": 1060.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 79.96, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 232.39 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 124.06 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 258.6 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 258.6 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 122.39, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 114.23, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 86.49, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 134.62, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 85.67, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.67, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 134.62, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 81.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 81.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 81.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 122.39, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "DIABETES - SOI : 4", "code_information": [ { "code": "4204", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 22267.11, "maximum": 23603.13, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 23196.33 } ] } ] }, { "description": "NEUROSES EXCEPT DEPRESSIVE", "code_information": [ { "code": "882", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 3988.44, "maximum": 25520.4, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 3988.44 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 10294.52 } ] } ] }, { "description": "STENT RESOLUTE ONYX 20026UX", "code_information": [ { "code": "C1874", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 4258.8, "10th_percentile": 4258.8, "90th_percentile": 4420.0, "count": "1 through 10" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1456.46, "10th_percentile": 975.0, "90th_percentile": 4680.0, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1444.95, "10th_percentile": 1444.95, "90th_percentile": 1444.95, "count": "1 through 10" } ] } ] }, { "description": "OTHER PERCUTANEOUS INTRACRANIAL PROCEDURES- SOI : 2", "code_information": [ { "code": "0292", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 41256.6, "maximum": 43732.0, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 42978.28 } ] } ] }, { "description": "VAGINAL DELIVERY - SOI : 3", "code_information": [ { "code": "5603", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 5598.29, "maximum": 8179.22, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 8179.22 } ] } ] }, { "description": "EXC ABD LES SC 3 CM>", "code_information": [ { "code": "22903", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 18750.0, "discounted_cash": 3562.0, "minimum": 1157.6054, "maximum": 15000.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1157.61, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 3084.12 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 1646.41 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 3431.96 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 3431.96 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1771.85, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 1653.72, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 1252.1, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1949.03, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1240.29, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1240.29, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1949.03, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1181.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1181.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 1181.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1771.85, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "OTHER DISORDERS OF NERVOUS SYSTEM WITH MCC", "code_information": [ { "code": "091", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 16836.6894, "maximum": 33777.0, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 17327.1 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 16836.69 } ] } ] }, { "description": "TIBIAL INSERT VKS CS RT", "code_information": [ { "code": "C1776", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 4588.1, "10th_percentile": 1617.12, "90th_percentile": 11630.3, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 9120.0, "10th_percentile": 9120.0, "90th_percentile": 9120.0, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 8640.0, "10th_percentile": 8640.0, "90th_percentile": 9120.0, "count": "1 through 10" } ] } ] }, { "description": "Unlisted px hands/fingers", "code_information": [ { "code": "26989", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2651.25, "discounted_cash": 503.0, "minimum": 98.3038, "maximum": 2121.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 98.3, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 286.8 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 153.1 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 319.15 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 319.15 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 150.47, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 140.43, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 106.33, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 165.51, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 105.33, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 105.33, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 165.51, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 100.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 100.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 100.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 150.47, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "STENT EVERFLEX 6MMX100M", "code_information": [ { "code": "C1876", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 3100.8, "10th_percentile": 1880.29, "90th_percentile": 7522.24, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 3482.69, "10th_percentile": 3482.69, "90th_percentile": 3482.69, "count": "1 through 10" } ] } ] }, { "description": "GUIDEWIRE 030.X145CM", "code_information": [ { "code": "C1769", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 228.66, "10th_percentile": 43.17, "90th_percentile": 1333.19, "count": "49" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 200.16, "10th_percentile": 45.57, "90th_percentile": 746.52, "count": "29" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 130.22, "10th_percentile": 39.18, "90th_percentile": 442.41, "count": "15" } ] } ] }, { "description": "PARVO B19 IGG-IGM/PARVOVIRUS A", "code_information": [ { "code": "86747", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 142.23, "discounted_cash": 27.0, "minimum": 13.0761, "maximum": 113.784, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14.73, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.21 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 60.72 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 13.08 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.21 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 67.48 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 67.48 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.55, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 21.04, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 15.93, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 24.8, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 15.78, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.48 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 29.68 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.78, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 26.77 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.21 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28.0 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 24.8, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 15.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.59 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 15.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 15.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 24.61 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 22.55, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "Zika Virus Comp Prof, NAA", "code_information": [ { "code": "87798", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 298.75, "discounted_cash": 33.0, "minimum": 7.5, "maximum": 749.52, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 34.39, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 49.51 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 141.76 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 30.53 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 49.51 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 157.55 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 157.55 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 52.64, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 49.13, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 37.2, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 57.9, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 36.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 52.48 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 69.3 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 62.49 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 49.51 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 65.38 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 57.9, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 48.07 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 57.44 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 52.64, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "PLATE VA-LCP SHORT 2.7X3.5 MM", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "ANAL AND PERINEAL PROCEDURES- SOI : 2", "code_information": [ { "code": "2262", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 15541.9, "maximum": 16474.41, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 16190.48 } ] } ] }, { "description": "OTHER DISORDERS OF THE EYE WITHOUT MCC", "code_information": [ { "code": "125", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 3857.8772, "maximum": 17263.8, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 6537.65 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 7360.9 } ] } ] }, { "description": "TESTES PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "712", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 4883.535, "maximum": 15762.6, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 8899.58 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 10542.82 } ] } ] }, { "description": "CYSTINE QN", "code_information": [ { "code": "82131", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 406.0, "discounted_cash": 77.0, "minimum": 19.9926, "maximum": 324.8, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.52, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 32.42 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 92.84 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 19.99 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 32.42 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 103.18 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 103.18 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 34.47, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 32.17, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 24.36, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 37.92, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 24.13, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 34.37 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 45.38 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.13, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 40.92 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 32.42 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 42.81 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 37.92, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 22.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.48 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 22.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 22.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 27.61 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 34.47, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "CONCUSSION, CLOSED SKULL FX NOS,UNCOMPLICATED INTRACRANIAL INJURY, COMA < 1 HR OR NO COMA - SOI : 4", "code_information": [ { "code": "0574", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 46591.31, "maximum": 49386.79, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 48535.61 } ] } ] }, { "description": "ALTERATION IN CONSCIOUSNESS - SOI : 1", "code_information": [ { "code": "0521", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 7187.44, "maximum": 7618.68, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 7487.37 } ] } ] }, { "description": "THER/DIAG CONCURRENT INF(ICU)", "code_information": [ { "code": "96368", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 298.48, "discounted_cash": 45.0, "minimum": 18.4962, "maximum": 1181.0, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 57.61 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 18.5 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 63.99 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 63.99 }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 45.37, "10th_percentile": 42.98, "90th_percentile": 238.78, "count": "34" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 45.37, "10th_percentile": 45.37, "90th_percentile": 45.37, "count": "12" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 45.37, "10th_percentile": 42.98, "90th_percentile": 50.96, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 298.48 } ] } ] }, { "description": "CT SINUS W/CONTRAST", "code_information": [ { "code": "70487", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2713.0, "discounted_cash": 620.0, "minimum": 69.8936, "maximum": 2613.6, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 69.89, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 227.2 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 736.17 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 158.53 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 227.2 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 818.17 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 818.17 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 106.98, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 99.85, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 75.6, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 980.1, "10th_percentile": 980.1, "90th_percentile": 980.1, "count": "1 through 10" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 620.73, "10th_percentile": 620.73, "90th_percentile": 633.8, "count": "1 through 10" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 117.68, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 74.89, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 240.83 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 317.99 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 74.89, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 286.75 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 227.2 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 299.99 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 117.68, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 71.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 220.58 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 71.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 71.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 620.73, "10th_percentile": 620.73, "90th_percentile": 620.73, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 298.8 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 106.98, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "GUIDEWIRE 6CMTIP L180CM", "code_information": [ { "code": "C1769", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 228.66, "10th_percentile": 43.17, "90th_percentile": 1333.19, "count": "49" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 200.16, "10th_percentile": 45.57, "90th_percentile": 746.52, "count": "29" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 130.22, "10th_percentile": 39.18, "90th_percentile": 442.41, "count": "15" } ] } ] }, { "description": "SPINAL FUSION AND OTHER BACK AND NECK PROCEDURES EXCEPT FOR DISC PROCEDURES- SOI : 3", "code_information": [ { "code": "3213", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 37815.69, "maximum": 40084.63, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 39393.77 } ] } ] }, { "description": "XR SCAPULA COMP-LT", "code_information": [ { "code": "73010", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 562.55, "discounted_cash": 91.0, "minimum": 41.6598, "maximum": 503.24, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 41.66, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 135.95 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 452.8 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 97.51 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 135.95 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 503.24 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 503.24 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 315.03, "10th_percentile": 315.03, "90th_percentile": 315.03, "count": "1 through 10" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 63.77, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 59.51, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 45.06, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 86.63, "10th_percentile": 86.63, "90th_percentile": 86.63, "count": "1 through 10" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 70.14, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 44.64, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 144.11 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 190.28 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 44.64, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "QTC Medical Group", "plan_name": "QTC Medical Group", "methodology": "fee schedule", "standard_charge_dollar": 51.82 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 171.59 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 135.95 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 179.51 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 70.14, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 42.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 131.99 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 91.44, "10th_percentile": 91.44, "90th_percentile": 91.44, "count": "1 through 10" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 42.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 42.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 68.82 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 63.77, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "MUSCULOSKELETAL MALIGNANCY & PATHOL FRACTURE DT MUSCSKEL MALIG - SOI : 1", "code_information": [ { "code": "3431", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 13820.01, "maximum": 14649.21, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 14396.73 } ] } ] }, { "description": "TRANSURETHRAL PROSTATECTOMY - SOI : 4", "code_information": [ { "code": "4824", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 44091.09, "maximum": 46736.55, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 45931.05 } ] } ] }, { "description": "CHEST PAIN - SOI : 3", "code_information": [ { "code": "2033", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 7577.08, "maximum": 8031.71, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 7893.28 } ] } ] }, { "description": "PLATE 4.5MM LCP 4 HOLE", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "ALPHA-1-ANTITRYPSIN TOTAL(REF)", "code_information": [ { "code": "82103", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 194.06, "discounted_cash": 36.0, "minimum": 10.89, "maximum": 286.6, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13.17, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.96 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 54.3 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 11.69 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.96 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 60.35 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 60.35 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 108.67, "10th_percentile": 108.67, "90th_percentile": 108.67, "count": "1 through 10" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 20.16, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 18.82, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 14.25, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 34.93, "10th_percentile": 34.93, "90th_percentile": 149.56, "count": "1 through 10" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 22.18, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 14.11, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.1 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26.54 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.11, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 23.93 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.96 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.04 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 22.18, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.41 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 22.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 20.16, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "PACEMAKER EVENTRECORABLE", "code_information": [ { "code": "C1764", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 7650.0, "10th_percentile": 6480.0, "90th_percentile": 8075.0, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 7650.0, "10th_percentile": 7650.0, "90th_percentile": 7650.0, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 7682.4, "10th_percentile": 7682.4, "90th_percentile": 7682.4, "count": "1 through 10" } ] } ] }, { "description": "Cor hlx vlgs dstl mtar osteo", "code_information": [ { "code": "28296", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7953.75, "discounted_cash": 1511.0, "minimum": 1193.0625, "maximum": 6363.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1303.98, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 3640.81 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 1943.59 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 4051.43 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 4051.43 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1995.89, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 1862.83, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 1410.43, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2195.47, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1397.12, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1397.12, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2195.47, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1330.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1330.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 1330.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1995.89, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "LYMPHATIC & OTHER MALIGNANCIES & NEOPLASMS OF UNCERTAIN BEHAVIOR - SOI : 4", "code_information": [ { "code": "6944", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 73751.91, "maximum": 78177.03, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 76829.65 } ] } ] }, { "description": "Closed Tx Radial/Ulnar FX W MA", "code_information": [ { "code": "25565", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3940.02, "discounted_cash": 748.0, "minimum": 591.003, "maximum": 3152.016, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 640.82, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 1802.67 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 962.33 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 2005.98 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 2005.98 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 980.85, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 915.46, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 693.13, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1078.94, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 686.6, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 686.6, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1078.94, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 653.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 653.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 653.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 980.85, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "GAMMA NAIL SCREW 12X100", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "1/2 1000ML/KCL 20MEQ", "drug_information": { "unit": 1000.0, "type": "ML" }, "code_information": [ { "code": "00338070434", "type": "NDC" }, { "code": "J3480", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 32.69, "10th_percentile": 26.92, "90th_percentile": 65.39, "count": "1 through 10" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 10.64, "10th_percentile": 9.14, "90th_percentile": 24.51, "count": "39" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 24.6, "median_amount": 0.14, "10th_percentile": 0.1, "90th_percentile": 0.41, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 10.64, "10th_percentile": 9.14, "90th_percentile": 10.64, "count": "12" } ] } ] }, { "description": "PCR SARS/COV2/FLU A&B/RSV", "code_information": [ { "code": "87637", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 784.47, "discounted_cash": 149.0, "minimum": 117.6705, "maximum": 627.576, "payers_information": [ { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 213.95, "10th_percentile": 213.95, "90th_percentile": 235.34, "count": "57" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 152.19, "10th_percentile": 141.2, "90th_percentile": 167.41, "count": "1 through 10" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 235.34, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 149.76, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 213.34 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 281.69 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 149.76, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 254.02 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 201.26 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 265.74 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 235.34, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "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": "fee schedule", "standard_charge_dollar": 195.4 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 142.63, "10th_percentile": 142.63, "90th_percentile": 149.05, "count": "1 through 10" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 142.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 142.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 152.19, "10th_percentile": 152.19, "90th_percentile": 152.19, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 171.12 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 213.95, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 139.78, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 201.26 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 142.63 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 142.63 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 201.26 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 142.63 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 142.63 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 484.94, "10th_percentile": 439.3, "90th_percentile": 533.44, "count": "25" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 213.95, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 199.68, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 151.19, "additional_payer_notes": "106.00% of Medicare Rates" } ] } ] }, { "description": "STENT COR XIENCE SIERRA 3.0X23", "code_information": [ { "code": "C1874", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 4258.8, "10th_percentile": 4258.8, "90th_percentile": 4420.0, "count": "1 through 10" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1456.46, "10th_percentile": 975.0, "90th_percentile": 4680.0, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1444.95, "10th_percentile": 1444.95, "90th_percentile": 1444.95, "count": "1 through 10" } ] } ] }, { "description": "CATH MAVERICK 5.0/15/150", "code_information": [ { "code": "C1725", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 462.76, "10th_percentile": 256.45, "90th_percentile": 2515.23, "count": "21" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 270.69, "10th_percentile": 106.59, "90th_percentile": 1342.29, "count": "14" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 484.0, "10th_percentile": 143.56, "90th_percentile": 543.74, "count": "1 through 10" } ] } ] }, { "description": "DIPRIVAN", "drug_information": { "unit": 20.0, "type": "ML" }, "code_information": [ { "code": "00409469924", "type": "NDC" }, { "code": "J2704", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 75.0, "median_amount": 84.0, "10th_percentile": 84.0, "90th_percentile": 84.0, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 62.72, "10th_percentile": 31.36, "90th_percentile": 94.08, "count": "19" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 20.16, "10th_percentile": 10.64, "90th_percentile": 35.85, "count": "37" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 10.64, "10th_percentile": 10.64, "90th_percentile": 31.92, "count": "45" } ] } ] }, { "description": "Proctosigmoidoscopy removal", "code_information": [ { "code": "45308", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3535.0, "discounted_cash": 671.0, "minimum": 530.25, "maximum": 3469.39, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1106.18, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 3117.76 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 1664.37 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 3469.39 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 3469.39 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1693.13, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 1580.25, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 1196.48, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1862.44, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1185.19, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1185.19, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1862.44, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1128.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1128.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 1128.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1693.13, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "IUD REMOVAL", "code_information": [ { "code": "58301", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 603.0, "discounted_cash": 114.0, "minimum": 37.15, "maximum": 482.4, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 121.44, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 50.24 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 37.15 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 55.99 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 55.99 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 185.88, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 173.49, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 131.36, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 204.47, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 130.12, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 130.12, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 204.47, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 123.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 123.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 123.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 185.88, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "OTHER VASCULAR PROCEDURES WITH CC", "code_information": [ { "code": "253", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 12254.7866, "maximum": 28522.8, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 25297.2 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 24884.02 } ] } ] }, { "description": "OTHER MENTAL DISORDER DIAGNOSES", "code_information": [ { "code": "887", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 10266.7183, "maximum": 24769.8, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 10572.3 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 10266.72 } ] } ] }, { "description": "Laparoscopy remove adnexa", "code_information": [ { "code": "58661", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4418.75, "discounted_cash": 839.0, "minimum": 662.8125, "maximum": 4418.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2409.3, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 4418.75 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 3431.93 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 4418.75 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 4418.75 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3687.71, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 3441.86, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 2605.98, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4056.48, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2581.39, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2581.39, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 24.6, "median_amount": 2568.84, "10th_percentile": 2568.84, "90th_percentile": 2568.84, "count": "1 through 10" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4056.48, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2458.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2458.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 2458.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3687.71, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "DORSAL & LUMBAR FUSION PROC EXCEPT FOR CURVATURE OF BACK - SOI : 3", "code_information": [ { "code": "3043", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 66248.37, "maximum": 70223.27, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 69012.97 } ] } ] }, { "description": "COLONOSCOPY AND BIOPSY-NONSNAR - 45380 - 409232", "code_information": [ { "code": "45380", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3859.44, "discounted_cash": 733.0, "minimum": 346.4295, "maximum": 3087.552, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 476.89, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 1335.61 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 713.0 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 1486.25 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 1486.25 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 729.93, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 681.27, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 515.82, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 802.92, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 510.95, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 510.95, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 802.92, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 486.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 486.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 486.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 729.93, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "OTHER SKIN, SUBCUTANEOUS TISSUE & BREAST DISORDERS - SOI : 2", "code_information": [ { "code": "3852", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 8460.47, "maximum": 8968.1, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 8813.53 } ] } ] }, { "description": "FEMORAL WDGE POSTERIOR SZ4 110", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "TENODESIS BICEP TENDON AT ELBO", "code_information": [ { "code": "24340", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 28032.1, "discounted_cash": 5326.0, "minimum": 2891.8036, "maximum": 22425.68, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2891.8, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 7955.99 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 4247.18 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 8853.29 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 8853.29 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4426.23, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 4131.15, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 3127.87, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4868.85, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3098.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3098.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4868.85, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2950.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2950.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 2950.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4426.23, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "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", "minimum": 13736.241, "maximum": 41283.0, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 24003.3 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 29860.63 } ] } ] }, { "description": "PROMOS ANATOMIC BALLHEAD", "code_information": [ { "code": "C1776", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 4588.1, "10th_percentile": 1617.12, "90th_percentile": 11630.3, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 9120.0, "10th_percentile": 9120.0, "90th_percentile": 9120.0, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 8640.0, "10th_percentile": 8640.0, "90th_percentile": 9120.0, "count": "1 through 10" } ] } ] }, { "description": "medical team conf. pt not pres", "code_information": [ { "code": "99368", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 790.0, "discounted_cash": 150.0, "minimum": 33.234, "maximum": 632.0, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 103.52 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 33.23 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 114.98 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 114.98 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 79.0 } ] } ] }, { "description": "STENT SENTINOL 8 X 81 MM", "code_information": [ { "code": "C1876", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 3100.8, "10th_percentile": 1880.29, "90th_percentile": 7522.24, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 3482.69, "10th_percentile": 3482.69, "90th_percentile": 3482.69, "count": "1 through 10" } ] } ] }, { "description": "CATH QUANTUM 12MM X 2.5M - C1725 - 050103", "code_information": [ { "code": "C1725", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 462.76, "10th_percentile": 256.45, "90th_percentile": 2515.23, "count": "21" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 270.69, "10th_percentile": 106.59, "90th_percentile": 1342.29, "count": "14" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 484.0, "10th_percentile": 143.56, "90th_percentile": 543.74, "count": "1 through 10" } ] } ] }, { "description": "UREA NITROGEN, URINE", "code_information": [ { "code": "84540", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10.0, "discounted_cash": 1.0, "minimum": 1.5, "maximum": 10.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5.45, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.85 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 10.0 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 4.84 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.85 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 10.0 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 10.0 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.34, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 7.78, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 5.89, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9.17, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.32 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.0 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 9.91 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.85 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.0 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.17, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.62 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 5.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 7.78 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.34, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "MAMMOGM DIAG BI", "code_information": [ { "code": "77066", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 451.93, "discounted_cash": 85.0, "minimum": 18.0345, "maximum": 451.93, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 102.79, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 451.93 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 104.72 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 451.93 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 451.93 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 157.34, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 146.85, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 111.18, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 110.13, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 110.13, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 173.07, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 104.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 104.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 104.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 144.43 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 157.34, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "IGM", "code_information": [ { "code": "82784", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 150.0, "discounted_cash": 28.0, "minimum": 3.645, "maximum": 120.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.11, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.12 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 37.57 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 8.09 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.12 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 41.76 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 41.76 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 84.0, "10th_percentile": 44.94, "90th_percentile": 102.0, "count": "1 through 10" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13.95, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 13.02, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 9.86, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 27.0, "10th_percentile": 27.0, "90th_percentile": 64.02, "count": "1 through 10" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15.35, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 9.77, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.91 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.37 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.77, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 16.56 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.12 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.33 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.35, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "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": "fee schedule", "standard_charge_dollar": 12.74 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 28.5, "10th_percentile": 28.5, "90th_percentile": 28.5, "count": "1 through 10" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 9.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 9.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 15.22 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 13.95, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "LVR FIB FIBROTEST-ACTITEST PNL", "code_information": [ { "code": "81596", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 11.4, "discounted_cash": 2.0, "minimum": 1.71, "maximum": 11.4, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11.4, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 11.4 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 11.4 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 11.4 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 11.4 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11.4, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 11.4, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 11.4, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11.4, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 11.4, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.4, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.4, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 11.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 11.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 11.4 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11.4, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "OTHER PROCEDURES OF BLOOD & BLOOD-FORMING ORGANS - SOI : 4", "code_information": [ { "code": "6514", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 103143.42, "maximum": 109332.03, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 107447.7 } ] } ] }, { "description": "RESPIRATORY FAILURE - SOI : 3", "code_information": [ { "code": "1333", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 18545.42, "maximum": 19658.14, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 19319.33 } ] } ] }, { "description": "INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITH CC OR TPA IN 24 HOURS", "code_information": [ { "code": "065", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 9234.8, "maximum": 21016.8, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 9234.8 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 9685.75 } ] } ] }, { "description": "MAJOR CHEST PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "165", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 8813.9148, "maximum": 18351.4354, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 15799.8 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 18351.44 } ] } ] }, { "description": "ESTIM UNATT OTHER WOUND", "code_information": [ { "code": "G0282", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 125.5, "minimum": 12.195, "maximum": 112.0, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 101.0 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 93.0 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 112.0 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 112.0 } ] } ] }, { "description": "LQ BSD PAP RF HGH RSKHPV", "code_information": [ { "code": "87624", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 41.0, "discounted_cash": 7.0, "minimum": 6.15, "maximum": 41.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 34.39, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 41.0 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 41.0 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 30.53 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 41.0 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 41.0 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 41.0 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 41.0, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 41.0, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 37.2, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 41.0, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 36.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 41.0 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 41.0 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 41.0 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 41.0 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 41.0 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 41.0, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 41.0 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 41.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 41.0, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "NEONATE BWT 2000-2499G, NORMAL NEWBORN OR NEONATE W OTHER PROBLEM - SOI : 1", "code_information": [ { "code": "6261", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 2168.84, "maximum": 2298.97, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 2259.34 } ] } ] }, { "description": "PARTIAL THICKNESS BURNS WO SKIN GRAFT - SOI : 3", "code_information": [ { "code": "8443", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 13638.55, "maximum": 14456.87, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 14207.7 } ] } ] }, { "description": "CPR - 92950 - 940177", "code_information": [ { "code": "92950", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1623.5, "discounted_cash": 291.0, "minimum": 74.625, "maximum": 1298.8, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 86.05, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 336.62 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 179.7 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 374.59 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 374.59 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 131.72, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 122.93, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 93.08, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 292.23, "10th_percentile": 235.41, "90th_percentile": 308.46, "count": "1 through 10" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 144.89, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 92.2, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 92.2, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 24.6, "median_amount": 708.18, "10th_percentile": 708.18, "90th_percentile": 708.18, "count": "1 through 10" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 144.89, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 87.81, "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": 19.0, "median_amount": 308.47, "10th_percentile": 308.47, "90th_percentile": 308.47, "count": "1 through 10" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 87.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 87.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 94.53, "10th_percentile": 94.53, "90th_percentile": 94.53, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 131.72, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "CULT ANAEROBIC/CULTBACT XPTBLD", "code_information": [ { "code": "87075", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 449.63, "discounted_cash": 85.0, "minimum": 8.2389, "maximum": 359.704, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.28, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.37 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 38.26 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 8.24 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.37 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 42.52 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 42.52 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 305.75, "10th_percentile": 305.75, "90th_percentile": 305.75, "count": "1 through 10" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14.21, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 13.26, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 10.04, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 87.23, "10th_percentile": 80.93, "90th_percentile": 449.63, "count": "1 through 10" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15.63, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 9.94, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.17 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.71 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.94, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 16.87 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.37 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.65 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.63, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 9.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.98 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 9.47, "10th_percentile": 9.47, "90th_percentile": 85.43, "count": "1 through 10" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 9.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 9.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 80.93, "10th_percentile": 9.47, "90th_percentile": 85.43, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 15.49 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.21, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "SCREW LAG LG 55MM30", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "PT MANUAL THERAPY 15 MIN", "code_information": [ { "code": "97140", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 144.78, "discounted_cash": 29.0, "minimum": 21.717, "maximum": 124.304, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 26.49, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 77.15 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 24.77 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 85.69 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 85.69 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 89.5, "10th_percentile": 81.08, "90th_percentile": 162.15, "count": "12" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 40.55, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 37.84, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 28.65, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 95.14, "10th_percentile": 86.87, "90th_percentile": 299.45, "count": "1 through 10" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 28.09, "10th_percentile": 27.51, "90th_percentile": 55.02, "count": "1 through 10" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 44.6, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 28.38, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.38, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 24.6, "median_amount": 86.5, "10th_percentile": 86.5, "90th_percentile": 86.5, "count": "1 through 10" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 44.6, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 27.03, "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": 19.0, "median_amount": 55.02, "10th_percentile": 27.51, "90th_percentile": 82.52, "count": "20" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 27.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 27.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 79.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.55, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "PANCREAS TRANSPLANT", "code_information": [ { "code": "010", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 42300.0, "maximum": 75681.1, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 75681.1 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 68793.44 } ] } ] }, { "description": "HIP HIGH DEMAND", "code_information": [ { "code": "C1776", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 4588.1, "10th_percentile": 1617.12, "90th_percentile": 11630.3, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 9120.0, "10th_percentile": 9120.0, "90th_percentile": 9120.0, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 8640.0, "10th_percentile": 8640.0, "90th_percentile": 9120.0, "count": "1 through 10" } ] } ] }, { "description": "3.5X14MM CORTICAL SCREW", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "EXTRACRANIAL PROCEDURES WITH CC", "code_information": [ { "code": "038", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 8550.0, "maximum": 17134.7, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 17134.7 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 15555.87 } ] } ] }, { "description": "BILIRUBIN TOT", "code_information": [ { "code": "82247", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 108.75, "discounted_cash": 20.0, "minimum": 4.3674, "maximum": 141.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4.92, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.09 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 20.28 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 4.37 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.09 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 22.54 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 22.54 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 73.95, "10th_percentile": 73.95, "90th_percentile": 73.95, "count": "1 through 10" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7.53, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 7.03, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 5.32, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.28, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5.27, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.51 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.92 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.27, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 8.94 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.09 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.36 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.28, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.88 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 8.21 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.53, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "TUMT", "code_information": [ { "code": "53850", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 15891.0, "discounted_cash": 3019.0, "minimum": 977.65, "maximum": 12712.8, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1404.8, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 1321.89 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 977.65 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 1473.36 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 1473.36 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2150.21, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 2006.86, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 1519.48, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2365.23, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1505.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1505.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2365.23, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1433.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1433.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 1433.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2150.21, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "STREP A OPTICAL IA", "code_information": [ { "code": "87880", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 198.0, "discounted_cash": 37.0, "minimum": 14.3811, "maximum": 158.4, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 75.0, "median_amount": 135.0, "10th_percentile": 135.0, "90th_percentile": 148.5, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 16.2, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.33 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 66.78 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 14.38 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.33 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 74.22 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 74.22 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 122.4, "10th_percentile": 110.88, "90th_percentile": 134.64, "count": "37" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.8, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 23.14, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 17.52, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 329.36, "10th_percentile": 214.84, "90th_percentile": 573.08, "count": "16" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 37.62, "10th_percentile": 35.64, "90th_percentile": 42.26, "count": "26" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 27.27, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 17.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.73 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 32.65 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 29.45 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.33 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.8 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 27.27, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 16.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.65 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 37.62, "10th_percentile": 37.62, "90th_percentile": 37.62, "count": "19" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 16.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 37.62, "10th_percentile": 35.64, "90th_percentile": 37.62, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 19.63 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 24.8, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "NON-ELECTIVE OR COMPLEX KNEE JOINT REPLACEMENT- SOI : 3", "code_information": [ { "code": "3253", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 34476.96, "maximum": 36545.58, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 35915.72 } ] } ] }, { "description": "SCREW 85MM", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "COW EPITHELIA", "code_information": [ { "code": "86003", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 52.51, "discounted_cash": 3.0, "minimum": 2.445, "maximum": 352.08, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5.12, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.36 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 21.09 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 4.54 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.36 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 23.44 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 23.44 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 37.06, "10th_percentile": 37.06, "90th_percentile": 222.36, "count": "1 through 10" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7.83, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 7.31, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 5.53, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.61, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.81 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.31 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 9.3 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.36 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.72 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.61, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "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": "fee schedule", "standard_charge_dollar": 7.15 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 10.36, "10th_percentile": 10.36, "90th_percentile": 10.36, "count": "1 through 10" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 8.54 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.83, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "MAJOR CARDIOTHORACIC REPAIR OF HEART ANOMALY - SOI : 1", "code_information": [ { "code": "1601", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 47683.85, "maximum": 50544.88, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 49673.74 } ] } ] }, { "description": "HYSTEROSCOPY BX/WWO D&C", "code_information": [ { "code": "58558", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8583.34, "discounted_cash": 1630.0, "minimum": 1287.501, "maximum": 6866.672, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1290.08, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 3322.47 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 1773.65 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 3697.19 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 3697.19 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1974.62, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 1842.97, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 1395.39, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2172.08, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1382.23, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1382.23, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2172.08, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1316.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1316.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 1316.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1974.62, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "CATH BALLOON EVERCROSS 200X135", "code_information": [ { "code": "C1725", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 462.76, "10th_percentile": 256.45, "90th_percentile": 2515.23, "count": "21" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 270.69, "10th_percentile": 106.59, "90th_percentile": 1342.29, "count": "14" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 484.0, "10th_percentile": 143.56, "90th_percentile": 543.74, "count": "1 through 10" } ] } ] }, { "description": "STENT EVERFLEX 6MM X 150MM", "code_information": [ { "code": "C1876", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 3100.8, "10th_percentile": 1880.29, "90th_percentile": 7522.24, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 3482.69, "10th_percentile": 3482.69, "90th_percentile": 3482.69, "count": "1 through 10" } ] } ] }, { "description": "HIV W MULTIPLE MAJOR HIV RELATED CONDITIONS - SOI : 3", "code_information": [ { "code": "8903", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 20964.47, "maximum": 22222.34, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 21839.33 } ] } ] }, { "description": "ART FX METACARP/PHAL W/MANIP - 26742 - 946669", "code_information": [ { "code": "26742", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7656.65, "discounted_cash": 1454.0, "minimum": 265.125, "maximum": 6125.32, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 640.82, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 1802.67 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 962.33 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 2005.98 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 2005.98 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 980.85, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 915.46, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 693.13, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1078.94, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 686.6, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 686.6, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1078.94, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 653.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 653.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 653.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 980.85, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "MESH SRG VITAMESH L6XW6IN", "code_information": [ { "code": "C1781", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1862.28, "10th_percentile": 1862.28, "90th_percentile": 11852.02, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1206.78, "10th_percentile": 1206.78, "90th_percentile": 1206.78, "count": "1 through 10" } ] } ] }, { "description": "BLADE SHVR L17MMXOD4.5M", "code_information": [ { "code": "A4649", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 10.66, "10th_percentile": 3.56, "90th_percentile": 309.79, "count": "12" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 9.49, "10th_percentile": 3.56, "90th_percentile": 336.36, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 9.49, "10th_percentile": 8.78, "90th_percentile": 73.99, "count": "1 through 10" } ] } ] }, { "description": "SCREW CORTEX 2.7X14MM", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "GROUP THERAPEUTIC PROCEDURES", "code_information": [ { "code": "97150", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 235.0, "discounted_cash": 44.0, "minimum": 7.05, "maximum": 188.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17.25, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 50.79 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 16.3 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 56.41 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 56.41 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 26.4, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 24.64, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 18.66, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 29.04, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 18.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 29.04, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 17.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 17.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 17.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 79.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 26.4, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "GUIDEWIRE VASC STEELCORE 0.018", "code_information": [ { "code": "C1769", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 228.66, "10th_percentile": 43.17, "90th_percentile": 1333.19, "count": "49" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 200.16, "10th_percentile": 45.57, "90th_percentile": 746.52, "count": "29" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 130.22, "10th_percentile": 39.18, "90th_percentile": 442.41, "count": "15" } ] } ] }, { "description": "Deoxycorticosterone (DOC)", "code_information": [ { "code": "82633", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 266.75, "discounted_cash": 50.0, "minimum": 26.9526, "maximum": 213.4, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 30.36, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 43.72 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 125.16 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 26.95 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 43.72 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 139.1 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 139.1 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 46.47, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 43.37, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 32.84, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 51.12, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 32.53, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 46.35 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 61.2 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 32.53, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 55.19 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 43.72 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 57.73 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 51.12, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 30.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 42.45 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 30.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 30.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 50.71 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 46.47, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "BASIC FOOD ALLERGY PROF(6)", "code_information": [ { "code": "86003", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 386.33, "discounted_cash": 3.0, "minimum": 2.445, "maximum": 352.08, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5.12, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.36 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 21.09 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 4.54 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.36 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 23.44 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 23.44 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 37.06, "10th_percentile": 37.06, "90th_percentile": 222.36, "count": "1 through 10" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7.83, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 7.31, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 5.53, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.61, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.81 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.31 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 9.3 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.36 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.72 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.61, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "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": "fee schedule", "standard_charge_dollar": 7.15 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 10.36, "10th_percentile": 10.36, "90th_percentile": 10.36, "count": "1 through 10" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 8.54 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.83, "additional_payer_notes": "150.00% 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", "minimum": 14146.7812, "maximum": 46537.2, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 27666.8 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 27516.61 } ] } ] }, { "description": "STENT NON COATED/DEL SYS 3X18", "code_information": [ { "code": "C1876", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 3100.8, "10th_percentile": 1880.29, "90th_percentile": 7522.24, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 3482.69, "10th_percentile": 3482.69, "90th_percentile": 3482.69, "count": "1 through 10" } ] } ] }, { "description": "PIN PAC E SMITH & NEPHEW", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "ELECTIVE HIP JOINT REPLACEMENT- SOI : 4", "code_information": [ { "code": "3244", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 48065.85, "maximum": 50949.81, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 50071.69 } ] } ] }, { "description": "BENZTROPINE COGENTIN", "code_information": [ { "code": "80299", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 179.0, "discounted_cash": 34.0, "minimum": 3.0, "maximum": 340.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.27, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26.31 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 75.31 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 16.22 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26.31 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 83.69 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 83.69 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 27.96, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 26.1, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 19.76, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 87.74, "10th_percentile": 52.01, "90th_percentile": 104.02, "count": "1 through 10" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 30.76, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 19.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.88 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 36.82 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 33.2 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26.31 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 34.73 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 30.76, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 18.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.54 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 18.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 104.02, "10th_percentile": 104.02, "90th_percentile": 104.02, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 22.42 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 27.96, "additional_payer_notes": "150.00% 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", "minimum": 15637.4716, "maximum": 47287.8, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 26714.1 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 34786.43 } ] } ] }, { "description": "HEMOGLOBIN (HB) A1C WITH EAG", "code_information": [ { "code": "83036", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 11.4, "discounted_cash": 2.0, "minimum": 1.71, "maximum": 128.8, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 75.0, "median_amount": 120.75, "10th_percentile": 120.75, "90th_percentile": 120.75, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.52, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.4 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 11.4 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 8.45 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.4 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 11.4 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 11.4 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 109.48, "10th_percentile": 90.16, "90th_percentile": 109.48, "count": "52" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11.4, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 11.4, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 10.29, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 30.59, "10th_percentile": 9.71, "90th_percentile": 34.36, "count": "177" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11.4, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 10.2, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.4 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.4 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.2, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 11.4 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.4 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.4 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.4, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 9.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.4 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 30.59, "10th_percentile": 9.71, "90th_percentile": 30.59, "count": "92" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 9.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 9.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 30.59, "10th_percentile": 28.98, "90th_percentile": 34.36, "count": "38" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 11.4 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11.4, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "SCREW CANNULATED LKNG 5.0X50MM", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "MAJOR O.R. PROCEDURES FOR LYMPHATICHEMATOPOIETICOTHER NEOPLASMS - SOI : 1", "code_information": [ { "code": "6801", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 22237.5, "maximum": 23571.75, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 23165.49 } ] } ] }, { "description": "Acetaminophen(ML)", "code_information": [ { "code": "80299", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 243.73, "discounted_cash": 34.0, "minimum": 3.0, "maximum": 340.0, "payers_information": [ { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26.31 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 34.73 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 30.76, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 18.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.54 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 18.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 104.02, "10th_percentile": 104.02, "90th_percentile": 104.02, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 22.42 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 27.96, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.27, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26.31 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 75.31 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 16.22 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26.31 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 83.69 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 83.69 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 27.96, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 26.1, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 19.76, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 87.74, "10th_percentile": 52.01, "90th_percentile": 104.02, "count": "1 through 10" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 30.76, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 19.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.88 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 36.82 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 33.2 } ] } ] }, { "description": "SCREW FULLY THREADED 6.5X50MM", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "AMPHETAMINES QL SQN", "code_information": [ { "code": "80299", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 25.0, "discounted_cash": 34.0, "minimum": 3.0, "maximum": 340.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.27, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.0 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 25.0 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 16.22 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.0 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 25.0 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 25.0 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 25.0, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 25.0, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 19.76, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 87.74, "10th_percentile": 52.01, "90th_percentile": 104.02, "count": "1 through 10" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 25.0, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 19.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.0 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.0 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 25.0 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.0 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.0 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 25.0, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 18.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.0 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 18.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 104.02, "10th_percentile": 104.02, "90th_percentile": 104.02, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 22.42 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 25.0, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "RESPIRATORY MALIGNANCY - SOI : 2", "code_information": [ { "code": "1362", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 14353.86, "maximum": 15215.09, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 14952.86 } ] } ] }, { "description": "INBORN ERRORS OF METABOLISM - SOI : 1", "code_information": [ { "code": "4231", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 19366.73, "maximum": 20528.73, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 20174.92 } ] } ] }, { "description": "XR ORBITS 4+V", "code_information": [ { "code": "70200", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 622.5, "discounted_cash": 118.0, "minimum": 41.6598, "maximum": 503.24, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 41.66, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 135.95 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 452.8 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 97.51 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 135.95 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 503.24 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 503.24 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 63.77, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 59.51, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 45.06, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 70.14, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 44.64, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 144.11 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 190.28 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 44.64, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "QTC Medical Group", "plan_name": "QTC Medical Group", "methodology": "fee schedule", "standard_charge_dollar": 97.59 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 171.59 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 135.95 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 179.51 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 70.14, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 42.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 131.99 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 42.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 42.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 132.84, "10th_percentile": 132.84, "90th_percentile": 132.84, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 68.82 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 63.77, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "THYRIOD STIMULATING IMMUNOGLOB", "code_information": [ { "code": "84445", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 394.0, "discounted_cash": 74.0, "minimum": 18.33, "maximum": 315.2, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 49.84, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 71.77 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 205.47 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 44.25 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 71.77 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 228.36 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 228.36 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 76.29, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 71.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 53.91, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 83.92, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 53.4, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 76.08 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 100.45 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 53.4, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 90.58 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 71.77 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 94.76 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 83.92, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "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": "fee schedule", "standard_charge_dollar": 69.68 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 50.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 50.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 83.26 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 76.29, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "DSMT GROUP EACH 30 MIN", "code_information": [ { "code": "G0109", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 98.18, "minimum": 13.485, "maximum": 78.544, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 42.01 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 13.49 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 46.66 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 46.66 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 23.45, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 21.88, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 16.57, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 25.79, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 16.41, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.41, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 25.79, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 15.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 15.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 15.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 73.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 23.45, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "M TUBERCULOSIS COMPLEX PCR", "code_information": [ { "code": "87556", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 930.5, "discounted_cash": 176.0, "minimum": 36.2616, "maximum": 744.4, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 40.85, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 58.81 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 168.39 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 36.26 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 58.81 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 187.14 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 187.14 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 62.52, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 58.35, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 44.18, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 68.77, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 43.76, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 62.34 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 82.32 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 43.76, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 74.23 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 58.81 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 77.66 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 68.77, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 41.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 57.1 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 41.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 41.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 57.44 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 62.52, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "SCREW BNE 5MMX60MM SELF TPNG", "code_information": [ { "code": "c1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "HICKMAN CATHETER 9FR DL", "code_information": [ { "code": "C1751", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 298.58, "10th_percentile": 298.58, "90th_percentile": 298.58, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 298.58, "10th_percentile": 298.58, "90th_percentile": 298.58, "count": "1 through 10" } ] } ] }, { "description": "CATH SPRINTER LEGEND 3.5X15", "code_information": [ { "code": "C1725", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 462.76, "10th_percentile": 256.45, "90th_percentile": 2515.23, "count": "21" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 270.69, "10th_percentile": 106.59, "90th_percentile": 1342.29, "count": "14" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 484.0, "10th_percentile": 143.56, "90th_percentile": 543.74, "count": "1 through 10" } ] } ] }, { "description": "SCRW BNE 6.5MMX24MM THREAD", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "RESPIRATORY SIGNS AND SYMPTOMS", "code_information": [ { "code": "204", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 3659.765, "maximum": 15762.6, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 4890.62 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 7740.54 } ] } ] }, { "description": "BILIRUBIN TOT BLD", "code_information": [ { "code": "82247", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 108.75, "discounted_cash": 20.0, "minimum": 4.3674, "maximum": 141.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4.92, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.09 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 20.28 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 4.37 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.09 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 22.54 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 22.54 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 73.95, "10th_percentile": 73.95, "90th_percentile": 73.95, "count": "1 through 10" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7.53, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 7.03, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 5.32, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.28, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5.27, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.51 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.92 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.27, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 8.94 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.09 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.36 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.28, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.88 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 8.21 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.53, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "MRI UP JNT W/O CONT-RT", "code_information": [ { "code": "73221", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3998.75, "discounted_cash": 759.0, "minimum": 95.0796, "maximum": 3212.12, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 95.08, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 303.0 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 941.48 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 202.74 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 303.0 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1046.35 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 1046.35 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 2239.3, "10th_percentile": 2239.3, "90th_percentile": 3415.43, "count": "1 through 10" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 145.53, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 135.83, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 102.84, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 1199.63, "10th_percentile": 1199.63, "90th_percentile": 2499.0, "count": "1 through 10" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 759.76, "10th_percentile": 719.78, "90th_percentile": 1071.84, "count": "12" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 160.08, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 101.87, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 321.17 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 424.08 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 101.87, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 382.42 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 303.0 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 400.07 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 160.08, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 97.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 294.17 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 759.76, "10th_percentile": 759.76, "90th_percentile": 759.76, "count": "1 through 10" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 97.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 97.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 719.78, "10th_percentile": 719.78, "90th_percentile": 719.78, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 353.74 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 145.53, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "MODERATELY EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS- SOI : 4", "code_information": [ { "code": "9514", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 78666.41, "maximum": 83386.4, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 81949.24 } ] } ] }, { "description": "MALNUTRITION, FAILURE TO THRIVE & OTHER NUTRITIONAL DISORDERS - SOI : 3", "code_information": [ { "code": "4213", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 19175.73, "maximum": 20326.27, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 19975.95 } ] } ] }, { "description": "UNI FFEMORAL COMPONET", "code_information": [ { "code": "C1776", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 4588.1, "10th_percentile": 1617.12, "90th_percentile": 11630.3, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 9120.0, "10th_percentile": 9120.0, "90th_percentile": 9120.0, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 8640.0, "10th_percentile": 8640.0, "90th_percentile": 9120.0, "count": "1 through 10" } ] } ] }, { "description": "XR RIBS BI 3 V", "code_information": [ { "code": "71110", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 724.17, "discounted_cash": 137.0, "minimum": 41.6598, "maximum": 579.336, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 41.66, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 135.95 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 452.8 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 97.51 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 135.95 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 503.24 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 503.24 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 63.77, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 59.51, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 45.06, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 70.14, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 44.64, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 144.11 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 190.28 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 44.64, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "QTC Medical Group", "plan_name": "QTC Medical Group", "methodology": "fee schedule", "standard_charge_dollar": 97.59 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 171.59 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 135.95 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 179.51 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 70.14, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 42.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 131.99 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 42.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 42.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 109.07 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 63.77, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "OTHER DRUG ABUSE & DEPENDENCE - SOI : 3", "code_information": [ { "code": "7763", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 11014.18, "maximum": 11675.03, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 11473.81 } ] } ] }, { "description": "04E AB PANEL OBI", "code_information": [ { "code": "86870", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 340.99, "discounted_cash": 71.0, "minimum": 37.88, "maximum": 1500.336, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 142.84, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 340.99 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 246.57 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 340.99 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 340.99 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 218.64, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 204.06, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 154.51, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 240.5, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 153.05, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 153.05, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 240.5, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 145.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 145.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 145.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 340.99 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 218.64, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "TC99M SESTAMIBI PER DOSE", "code_information": [ { "code": "A9500", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1027.84, "minimum": 118.4331, "maximum": 822.272, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 75.0, "median_amount": 1541.76, "10th_percentile": 1541.76, "90th_percentile": 1541.76, "count": "1 through 10" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 344.41 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 118.43 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 382.53 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 382.53 }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 398.8, "10th_percentile": 370.02, "90th_percentile": 438.68, "count": "58" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 390.58, "10th_percentile": 390.58, "90th_percentile": 390.58, "count": "53" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 398.8, "10th_percentile": 199.4, "90th_percentile": 438.68, "count": "18" } ] } ] }, { "description": "RECTAL RESECTION WITH CC", "code_information": [ { "code": "333", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 9887.138, "maximum": 29017.1, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 29017.1 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 22454.67 } ] } ] }, { "description": "SCRW BNE 2.4X10MM SS T8 SLF TP", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "Exc back tum deep 5 cm/>", "code_information": [ { "code": "21933", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4124.17, "discounted_cash": 783.0, "minimum": 618.6255, "maximum": 3431.96, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1157.61, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 3084.12 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 1646.41 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 3431.96 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 3431.96 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1771.85, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 1653.72, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 1252.1, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1949.03, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1240.29, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1240.29, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1949.03, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1181.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1181.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 1181.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "percent of total billed charges", "standard_charge_percentage": 54.8, "median_amount": 5409.09, "10th_percentile": 5409.09, "90th_percentile": 5409.09, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1771.85, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "FEMALE REPRODUCTIVE SYSTEM RECONSTRUCTIVE PROCEDURES", "code_information": [ { "code": "748", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 6226.4494, "maximum": 16489.9, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 16489.9 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 13300.05 } ] } ] }, { "description": "TIBIA PLATE 6 HOLES 18MM LEFT", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "Angiography, Pulmonary Bilater", "code_information": [ { "code": "75743", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 17541.8, "discounted_cash": 3332.0, "minimum": 1258.3396, "maximum": 14033.44, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1258.34, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3941.43 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 11195.97 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2411.01 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3941.43 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 12443.05 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 12443.05 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1926.03, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 1797.63, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 1361.06, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2118.63, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1348.22, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4177.91 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5516.47 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1348.22, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 4974.62 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3941.43 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5204.22 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2118.63, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1284.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3826.63 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1284.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 1284.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 3091.73 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1926.03, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "Removal of Nail Plate (Part/Co", "code_information": [ { "code": "11730", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1010.16, "discounted_cash": 191.0, "minimum": 79.9582, "maximum": 808.128, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 79.96, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 232.39 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 124.06 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 258.6 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 258.6 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 122.39, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 114.23, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 86.49, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 134.62, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 85.67, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.67, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 24.6, "median_amount": 214.33, "10th_percentile": 214.33, "90th_percentile": 214.33, "count": "1 through 10" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 134.62, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 81.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 81.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 81.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 122.39, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "PERIPHERAL, CRANIAL & AUTONOMIC NERVE DISORDERS - SOI : 3", "code_information": [ { "code": "0483", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 10998.9, "maximum": 11658.83, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 11457.89 } ] } ] }, { "description": "GUIDING CATHETER XB 3.5", "code_information": [ { "code": "C1887", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 115.24, "10th_percentile": 81.0, "90th_percentile": 503.66, "count": "23" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 156.51, "10th_percentile": 102.6, "90th_percentile": 572.45, "count": "11" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 129.36, "10th_percentile": 24.35, "90th_percentile": 512.12, "count": "1 through 10" } ] } ] }, { "description": "INSERT CTRL LINE NON-TUN(INF)", "code_information": [ { "code": "36556", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3198.75, "discounted_cash": 566.0, "minimum": 447.537, "maximum": 13127.76, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1258.34, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 2169.4 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 1158.1 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 2414.07 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 2414.07 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1926.03, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 1797.63, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 1361.06, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2118.63, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1348.22, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1348.22, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2118.63, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1284.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1284.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 1284.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1926.03, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "BONE SCREW MINI ACUTRAK", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "GLUCOSE BODY FLD QN", "code_information": [ { "code": "82945", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 158.75, "discounted_cash": 2.0, "minimum": 1.6875, "maximum": 127.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3.85, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.54 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 15.88 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3.42 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.54 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 17.65 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 17.65 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5.9, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 5.5, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 4.17, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 4.13, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.87 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.76 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.13, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 6.99 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.54 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.32 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.38 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 3.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 6.43 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5.9, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "ESTRIOL UNCONJUGATED", "code_information": [ { "code": "82677", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 192.5, "discounted_cash": 36.0, "minimum": 5.7045, "maximum": 154.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 23.7, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 34.12 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 97.69 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 21.04 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 34.12 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 108.57 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 108.57 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 36.27, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 33.85, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 25.63, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 39.9, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 25.39, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 36.17 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 47.76 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.39, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 43.07 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 34.12 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 45.06 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 39.9, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 24.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 33.13 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 24.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 24.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 39.59 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 36.27, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "PACEMAKER CARDIAC EDORA 8DR-T", "code_information": [ { "code": "C1785", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 6147.84, "10th_percentile": 6147.84, "90th_percentile": 6147.84, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 6147.84, "10th_percentile": 6147.84, "90th_percentile": 6147.84, "count": "1 through 10" } ] } ] }, { "description": "SCREW 80MM", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "DIVERTICULITIS & DIVERTICULOSIS - SOI : 3", "code_information": [ { "code": "2443", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 11463.99, "maximum": 12151.83, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 11942.39 } ] } ] }, { "description": "STENT XIENCE ALPINE 3.5X8MM", "code_information": [ { "code": "C1876", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 3100.8, "10th_percentile": 1880.29, "90th_percentile": 7522.24, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 3482.69, "10th_percentile": 3482.69, "90th_percentile": 3482.69, "count": "1 through 10" } ] } ] }, { "description": "NM TESTICULAR W/FLOW", "code_information": [ { "code": "78761", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1892.5, "discounted_cash": 359.0, "minimum": 158.9664, "maximum": 1514.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 159.32, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 504.43 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 738.19 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 158.97 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 504.43 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 820.41 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 820.41 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 243.86, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 227.6, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 172.32, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 268.24, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 170.7, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 534.7 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 706.01 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 170.7, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 636.66 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 504.43 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 666.05 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 268.24, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 162.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 489.74 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 162.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 162.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 500.42 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 243.86, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "MALIGNANT BREAST DISORDERS - SOI : 4", "code_information": [ { "code": "3824", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 29967.38, "maximum": 31765.43, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 31217.95 } ] } ] }, { "description": "RESPIRATORY SIGNS, SYMPTOMS AND MISCELLANEOUS DIAGNOSES- SOI : 2", "code_information": [ { "code": "1442", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 8531.14, "maximum": 9043.01, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 8887.15 } ] } ] }, { "description": "GLUCOSE POST GLUCOSE DOS", "code_information": [ { "code": "82950", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 147.5, "discounted_cash": 2.0, "minimum": 2.25, "maximum": 118.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4.66, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.71 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 19.19 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 4.13 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.71 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 21.33 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 21.33 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7.13, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 6.65, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 5.04, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.84, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 4.99, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.11 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.38 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.99, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 8.46 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.71 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.85 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.84, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "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": "fee schedule", "standard_charge_dollar": 6.51 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 7.78 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.13, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITHOUT CCMCC", "code_information": [ { "code": "282", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 3350.359, "maximum": 12760.2, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 7877.67 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 6932.36 } ] } ] }, { "description": "SKIN GRAFT, EXCEPT HAND, FOR MUSCULOSKELETAL & CONNECTIVE TISSUE DIAGNOSES - SOI : 3", "code_information": [ { "code": "3123", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 36651.53, "maximum": 38850.62, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 38181.03 } ] } ] }, { "description": "CELLULITIS & OTHER SKIN INFECTIONS - SOI : 3", "code_information": [ { "code": "3833", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 11787.74, "maximum": 12495.0, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 12279.65 } ] } ] }, { "description": "STENT 19MX90CMXOD7M MONO", "code_information": [ { "code": "C1876", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 3100.8, "10th_percentile": 1880.29, "90th_percentile": 7522.24, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 3482.69, "10th_percentile": 3482.69, "90th_percentile": 3482.69, "count": "1 through 10" } ] } ] }, { "description": "ORGANIC MENTAL HEALTH DISTURBANCES - SOI : 1", "code_information": [ { "code": "7571", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 4187.74, "maximum": 4439.0, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 4362.49 } ] } ] }, { "description": "GTT 2HR", "code_information": [ { "code": "82951", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 232.5, "discounted_cash": 44.0, "minimum": 11.1969, "maximum": 186.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12.61, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.16 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 51.99 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 11.2 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.16 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 57.79 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 57.79 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.31, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 18.02, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 13.64, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.24, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 13.51, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.25 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.42 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.51, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 22.92 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.16 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.98 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.24, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.63 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 21.07 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.31, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "CT CHEST W&W/O CONT", "code_information": [ { "code": "71270", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5706.25, "discounted_cash": 1084.0, "minimum": 69.8936, "maximum": 4565.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 69.89, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 227.2 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 736.17 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 158.53 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 227.2 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 818.17 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 818.17 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 106.98, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 99.85, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 75.6, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 1711.88, "10th_percentile": 1711.88, "90th_percentile": 2727.86, "count": "1 through 10" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1217.71, "10th_percentile": 1107.01, "90th_percentile": 2771.07, "count": "1 through 10" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 117.68, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 74.89, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 240.83 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 317.99 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 74.89, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 286.75 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 227.2 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 299.99 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 117.68, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 71.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 220.58 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1084.19, "10th_percentile": 1084.19, "90th_percentile": 1084.19, "count": "1 through 10" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 71.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 71.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1084.19, "10th_percentile": 1084.19, "90th_percentile": 1084.19, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 336.48 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 106.98, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "OTHER STOMACH, ESOPHAGEAL & DUODENAL PROCEDURES - SOI : 1", "code_information": [ { "code": "2221", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 9204.42, "maximum": 9756.69, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 9588.53 } ] } ] }, { "description": "CATH QUANTUM 20MM X 4.0M", "code_information": [ { "code": "C1725", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 462.76, "10th_percentile": 256.45, "90th_percentile": 2515.23, "count": "21" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 270.69, "10th_percentile": 106.59, "90th_percentile": 1342.29, "count": "14" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 484.0, "10th_percentile": 143.56, "90th_percentile": 543.74, "count": "1 through 10" } ] } ] }, { "description": "CATH QUANTUM 9MM X 4.0M", "code_information": [ { "code": "C1725", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 462.76, "10th_percentile": 256.45, "90th_percentile": 2515.23, "count": "21" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 270.69, "10th_percentile": 106.59, "90th_percentile": 1342.29, "count": "14" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 484.0, "10th_percentile": 143.56, "90th_percentile": 543.74, "count": "1 through 10" } ] } ] }, { "description": "CANC SCREW 2333-50", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "HIV W ONE SIGNIF HIV COND OR WO SIGNIF RELATED COND - SOI : 2", "code_information": [ { "code": "8942", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 10023.83, "maximum": 10625.26, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 10442.13 } ] } ] }, { "description": "SCREW LONG THREAD 4.0X26MM", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "PLATE VA-LCP 2.7/3.5 2 HOLE", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "SCREW FAST THREAD BC IF 8X20MM", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "AUTOLOGOUS BONE MARROW TRANSPLANT OR T-CELL IMMUNOTHERAPY- SOI : 1", "code_information": [ { "code": "0081", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 62122.71, "maximum": 65850.07, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 64715.15 } ] } ] }, { "description": "MONORAIL STENT 8MMX2.75", "code_information": [ { "code": "C1874", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 4258.8, "10th_percentile": 4258.8, "90th_percentile": 4420.0, "count": "1 through 10" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1456.46, "10th_percentile": 975.0, "90th_percentile": 4680.0, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1444.95, "10th_percentile": 1444.95, "90th_percentile": 1444.95, "count": "1 through 10" } ] } ] }, { "description": "OT ULTRA SOUND 15 MIN", "code_information": [ { "code": "97035", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 154.97, "discounted_cash": 29.0, "minimum": 12.2322, "maximum": 123.976, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13.69, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 38.1 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.23 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 42.32 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 42.32 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 86.78, "10th_percentile": 86.78, "90th_percentile": 86.78, "count": "1 through 10" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 20.96, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 19.56, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 14.81, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 23.05, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 14.67, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.67, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 23.05, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 13.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 13.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 79.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 20.96, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "POST-OPERATIVE, POST-TRAUMATIC, OTHER DEVICE INFECTIONS - SOI : 3", "code_information": [ { "code": "7213", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 18422.22, "maximum": 19527.55, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 19191.0 } ] } ] }, { "description": "MONORAIL STENT 12MMX3.5", "code_information": [ { "code": "C1876", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 3100.8, "10th_percentile": 1880.29, "90th_percentile": 7522.24, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 3482.69, "10th_percentile": 3482.69, "90th_percentile": 3482.69, "count": "1 through 10" } ] } ] }, { "description": "REMOVE VAGINA LESION", "code_information": [ { "code": "57135", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2209.37, "discounted_cash": 419.0, "minimum": 331.4055, "maximum": 2209.37, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1290.08, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 2209.37 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 1773.65 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 2209.37 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 2209.37 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1974.62, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 1842.97, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 1395.39, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2172.08, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1382.23, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1382.23, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2172.08, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1316.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1316.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 1316.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1974.62, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "VIABILITY", "code_information": [ { "code": "78452", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3863.7, "discounted_cash": 734.0, "minimum": 356.178, "maximum": 5444.96, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 75.0, "median_amount": 5104.65, "10th_percentile": 5104.65, "90th_percentile": 5104.65, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 515.95, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1722.53 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 1653.98 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 356.18 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1722.53 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1838.21 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 1838.21 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 2878.96, "10th_percentile": 2878.96, "90th_percentile": 4628.22, "count": "1 through 10" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 789.72, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 737.07, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 558.07, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 2159.0, "10th_percentile": 2159.0, "90th_percentile": 2658.56, "count": "11" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1225.12, "10th_percentile": 976.79, "90th_percentile": 1797.99, "count": "82" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 868.69, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 552.8, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1825.88 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2410.87 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 552.8, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 2174.07 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1722.53 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2274.41 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 868.69, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 526.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1672.36 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 976.79, "10th_percentile": 976.79, "90th_percentile": 976.79, "count": "53" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 526.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 526.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1246.01, "10th_percentile": 976.79, "90th_percentile": 1452.44, "count": "17" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 1384.34 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 789.72, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "INTRACRANIAL HEMORRHAGE - SOI : 3", "code_information": [ { "code": "0443", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 20684.65, "maximum": 21925.73, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 21547.84 } ] } ] }, { "description": "WATER - 00264210100", "drug_information": { "unit": 1000.0, "type": "ML" }, "code_information": [ { "code": "00264210100", "type": "NDC" }, { "code": "A4217", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 24.6, "median_amount": 8.51, "10th_percentile": 8.51, "90th_percentile": 8.51, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 8.82, "10th_percentile": 8.82, "90th_percentile": 8.82, "count": "1 through 10" } ] } ] }, { "description": "JETX BAR TO BAR CLAMP", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "THER/PROPH/DIAG INJ IV PUSH(IC", "code_information": [ { "code": "96374", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 318.56, "discounted_cash": 189.0, "minimum": 34.4868, "maximum": 998.59, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 84.76, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 107.42 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 34.49 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 119.32 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 119.32 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 129.74, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 121.09, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 91.68, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 189.73, "10th_percentile": 127.26, "90th_percentile": 998.59, "count": "67" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 142.71, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 90.81, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 90.81, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 142.71, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 86.49, "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": 19.0, "median_amount": 189.73, "10th_percentile": 189.73, "90th_percentile": 189.73, "count": "15" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 86.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 86.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 189.73, "10th_percentile": 54.38, "90th_percentile": 213.1, "count": "12" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 318.56 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 129.74, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "SCREW BONE 2.7MM 5MM 20MM LCP", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "MINOR BLADDER PROCEDURES WITH MCC", "code_information": [ { "code": "662", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 13529.8164, "maximum": 54043.2, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 29612.3 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 29350.6 } ] } ] }, { "description": "AMPUTATION OF LOWER LIMB FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH CC", "code_information": [ { "code": "617", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 9393.4738, "maximum": 42784.2, "payers_information": [ { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "other", "standard_charge_dollar": 25650.0, "standard_charge_algorithm": "$4,500 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 22500.0, "10th_percentile": 22500.0, "90th_percentile": 22500.0, "count": "1 through 10" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 12999.2 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 17930.57 } ] } ] }, { "description": "MUCIN CLOT SYNOVIAL", "code_information": [ { "code": "83872", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 73.0, "discounted_cash": 13.0, "minimum": 5.0982, "maximum": 58.4, "payers_information": [ { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.79, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 8.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 6.21, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9.67, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 6.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.77 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.58 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 10.44 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.27 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.92 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.67, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.03 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 5.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 9.6 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.79, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5.74, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.27 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 23.67 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5.1 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.27 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 26.31 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 26.31 } ] } ] }, { "description": "VIRAL ILLNESS WITH MCC", "code_information": [ { "code": "865", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 6829.5602, "maximum": 30024.0, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 9404.98 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 14364.2 } ] } ] }, { "description": "ANTEPARTUM WITH O.R. PROCEDURE- SOI : 2", "code_information": [ { "code": "5472", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 10334.21, "maximum": 10954.26, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 10765.46 } ] } ] }, { "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", "minimum": 17550.0, "maximum": 29273.4, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 21344.6 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 21078.94 } ] } ] }, { "description": "TRACHEOSTOMY FOR FACE, MOUTH AND NECK DIAGNOSES OR LARYNGECTOMY WITH CC", "code_information": [ { "code": "012", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 37461.7, "maximum": 63801.0, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 37461.7 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 40418.79 } ] } ] }, { "description": "ALCOHOL, DRUG ABUSE OR DEPENDENCE WITH REHABILITATION THERAPY", "code_information": [ { "code": "895", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 6293.93, "maximum": 57045.6, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 6293.93 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 13571.36 } ] } ] }, { "description": "TRACHEOSTOMY W MV 96+ HOURS W EXTENSIVE PROCEDURE - SOI : 4", "code_information": [ { "code": "0044", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 244594.37, "maximum": 259270.03, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 254801.52 } ] } ] }, { "description": "SEIZURE - SOI : 3", "code_information": [ { "code": "0533", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 11685.55, "maximum": 12386.68, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 12173.2 } ] } ] }, { "description": "SCREW CORTEX 3.5X40MM", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "PLATE EPI OBLQ LT SM", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "GLUCAGON, PLASMA", "code_information": [ { "code": "82943", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 85.5, "discounted_cash": 16.0, "minimum": 12.4323, "maximum": 68.4, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14.0, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.17 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 57.73 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.43 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.17 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 64.16 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 64.16 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 21.44, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 20.01, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 15.15, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 23.58, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 15.0, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.38 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28.23 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.0, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 25.45 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.17 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26.63 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 23.58, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 14.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.58 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 14.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 23.39 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.44, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "THYROID CASCADE PROFILE LC", "code_information": [ { "code": "84443", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 84.0, "discounted_cash": 66.0, "minimum": 12.6, "maximum": 281.6, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 75.0, "median_amount": 240.0, "10th_percentile": 240.0, "90th_percentile": 264.0, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 16.46, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.71 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 67.87 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 14.62 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.71 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 75.43 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 75.43 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 197.12, "10th_percentile": 197.12, "90th_percentile": 239.36, "count": "33" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 25.2, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 23.52, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 17.81, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 66.88, "10th_percentile": 16.8, "90th_percentile": 75.12, "count": "211" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 27.72, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 17.64, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.13 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 33.19 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.64, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 29.93 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.71 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.31 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 27.72, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 16.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.02 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 66.88, "10th_percentile": 16.8, "90th_percentile": 66.88, "count": "152" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 16.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 66.88, "10th_percentile": 63.36, "90th_percentile": 75.12, "count": "68" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 27.52 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 25.2, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "EGD US TRANSMURAL INJXN/MARK", "code_information": [ { "code": "43253", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1798.19, "discounted_cash": 341.0, "minimum": 269.7285, "maximum": 1798.19, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 764.73, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 1798.19 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 1105.75 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 1798.19 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 1798.19 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1170.51, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 1092.48, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 827.16, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1287.56, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 819.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 819.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1287.56, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 780.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 780.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 780.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1170.51, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "FFR INITIAL VESSEL", "code_information": [ { "code": "93571", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5623.82, "discounted_cash": 1068.0, "minimum": 843.573, "maximum": 4499.056, "payers_information": [ { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1246.16, "10th_percentile": 1246.16, "90th_percentile": 1246.16, "count": "1 through 10" } ] } ] }, { "description": "LYMPHATIC & OTHER MALIGNANCIES & NEOPLASMS OF UNCERTAIN BEHAVIOR - SOI : 1", "code_information": [ { "code": "6941", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 7989.65, "maximum": 8469.03, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 8323.06 } ] } ] }, { "description": "REMOVE NASAL FOREIGN BODY", "code_information": [ { "code": "30300", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 532.4, "discounted_cash": 101.0, "minimum": 53.018, "maximum": 425.92, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 53.02, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 145.01 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 77.41 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 161.36 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 161.36 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 81.15, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 75.74, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 57.35, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 89.27, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 56.81, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 56.81, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 24.6, "median_amount": 134.9, "10th_percentile": 134.9, "90th_percentile": 136.29, "count": "1 through 10" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 89.27, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 54.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 54.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 54.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 81.15, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "POTASSIUM RBC", "code_information": [ { "code": "84999", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 375.0, "discounted_cash": 71.0, "minimum": 56.25, "maximum": 300.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 75.0, "median_amount": 7.27, "10th_percentile": 7.27, "90th_percentile": 7.27, "count": "1 through 10" } ] } ] }, { "description": "ASCEND HUMERAL STEM SIZE 5A", "code_information": [ { "code": "C1776", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 4588.1, "10th_percentile": 1617.12, "90th_percentile": 11630.3, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 9120.0, "10th_percentile": 9120.0, "90th_percentile": 9120.0, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 8640.0, "10th_percentile": 8640.0, "90th_percentile": 9120.0, "count": "1 through 10" } ] } ] }, { "description": "SCRW BNE 6.5MMX60MM", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT CCMCC", "code_information": [ { "code": "479", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 8355.3474, "maximum": 24769.8, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 14322.1 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 17821.27 } ] } ] }, { "description": "PREDNISONE - 00054001720", "drug_information": { "unit": 10.0, "type": "ME" }, "code_information": [ { "code": "00054001720", "type": "NDC" }, { "code": "J7512", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 3.36, "10th_percentile": 3.36, "90th_percentile": 4.08, "count": "1 through 10" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 0.64, "10th_percentile": 0.44, "90th_percentile": 1.71, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 0.57, "10th_percentile": 0.57, "90th_percentile": 1.14, "count": "1 through 10" } ] } ] }, { "description": "STENT BMS INTEGRITY 4.0X22MM", "code_information": [ { "code": "C1876", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 3100.8, "10th_percentile": 1880.29, "90th_percentile": 7522.24, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 3482.69, "10th_percentile": 3482.69, "90th_percentile": 3482.69, "count": "1 through 10" } ] } ] }, { "description": "AIRWAY INHALATION TREATMENT - 94640 - 034816", "code_information": [ { "code": "94640", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 192.8, "discounted_cash": 201.0, "minimum": 28.92, "maximum": 848.312, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 87.26, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 192.8 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 160.05 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 192.8 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 192.8 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 133.56, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 124.66, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 94.38, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 36.64, "10th_percentile": 36.64, "90th_percentile": 36.64, "count": "1 through 10" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 146.92, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 93.49, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 93.49, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 24.6, "median_amount": 48.85, "10th_percentile": 48.85, "90th_percentile": 48.85, "count": "1 through 10" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 146.92, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 89.04, "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": 19.0, "median_amount": 36.63, "10th_percentile": 36.63, "90th_percentile": 36.63, "count": "1 through 10" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 89.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 89.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 133.56, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "FEMORAL COMPONENT LEFT SZ 3+", "code_information": [ { "code": "C1776", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 4588.1, "10th_percentile": 1617.12, "90th_percentile": 11630.3, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 9120.0, "10th_percentile": 9120.0, "90th_percentile": 9120.0, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 8640.0, "10th_percentile": 8640.0, "90th_percentile": 9120.0, "count": "1 through 10" } ] } ] }, { "description": "ACTIVE DC ICD LEAD", "code_information": [ { "code": "C1898", "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": 19.0, "median_amount": 844.74, "10th_percentile": 844.74, "90th_percentile": 844.74, "count": "1 through 10" } ] } ] }, { "description": "SQ IMMUNIZATION INJ - 90471 - 009044", "code_information": [ { "code": "90471", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 67.46, "discounted_cash": 12.0, "minimum": 10.119, "maximum": 269.856, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 75.0, "median_amount": 252.99, "10th_percentile": 252.99, "90th_percentile": 252.99, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 28.69, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 67.46 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 52.61 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 67.46 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 67.46 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 188.9, "10th_percentile": 188.9, "90th_percentile": 229.38, "count": "1 through 10" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 43.92, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 40.99, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 31.04, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 64.09, "10th_percentile": 16.27, "90th_percentile": 71.98, "count": "19" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 48.31, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 30.74, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30.74, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 48.31, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 29.28, "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": 24.6, "median_amount": 15.25, "10th_percentile": 15.25, "90th_percentile": 67.46, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 64.09, "10th_percentile": 64.09, "90th_percentile": 64.09, "count": "12" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 29.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 29.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 32.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 43.92, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "VENTRICULAR SHUNT PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "033", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 6750.0, "maximum": 15942.2223, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 15241.4 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 15942.22 } ] } ] }, { "description": "CATHETER NC EUPHORA 2.75MMX15M", "code_information": [ { "code": "C1725", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 462.76, "10th_percentile": 256.45, "90th_percentile": 2515.23, "count": "21" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 270.69, "10th_percentile": 106.59, "90th_percentile": 1342.29, "count": "14" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 484.0, "10th_percentile": 143.56, "90th_percentile": 543.74, "count": "1 through 10" } ] } ] }, { "description": "SCREW TITANIUM LCKNG 5.0X54 T2", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "MAXIPIME - 44567013110", "drug_information": { "unit": 2.0, "type": "GR" }, "code_information": [ { "code": "44567013110", "type": "NDC" }, { "code": "J0692", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 8.76, "10th_percentile": 4.46, "90th_percentile": 29.5, "count": "1 through 10" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 24.6, "median_amount": 6.75, "10th_percentile": 6.75, "90th_percentile": 12.9, "count": "1 through 10" } ] } ] }, { "description": "SCREW BONE 2.7X22MM CORTEX", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "LEG/ABD SELECT 1ST ORDER ART", "code_information": [ { "code": "36245", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4459.61, "discounted_cash": 1165.0, "minimum": 668.9415, "maximum": 4907.88, "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 847.33, "10th_percentile": 847.33, "90th_percentile": 1309.18, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 847.33, "10th_percentile": 847.33, "90th_percentile": 847.33, "count": "1 through 10" } ] } ] }, { "description": "BRONCHOSCOPY W/BIOPSY(S)", "code_information": [ { "code": "31625", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3617.5, "discounted_cash": 687.0, "minimum": 542.625, "maximum": 2894.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 709.34, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 1902.71 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 1015.73 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 2117.3 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 2117.3 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1085.73, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 1013.35, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 767.25, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1194.3, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 760.01, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 760.01, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1194.3, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 723.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 723.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 723.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1085.73, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "BASE PLATE XLG XL-2", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "OTHER DISORDERS OF THE LIVER - SOI : 2", "code_information": [ { "code": "2832", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 8507.26, "maximum": 9017.7, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 8862.28 } ] } ] }, { "description": "CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITHOUT CCMCC", "code_information": [ { "code": "416", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 6567.7196, "maximum": 21016.8, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 19429.1 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 13069.96 } ] } ] }, { "description": "Removal of toe lesions", "code_information": [ { "code": "28108", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3535.0, "discounted_cash": 671.0, "minimum": 530.25, "maximum": 2828.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 640.82, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 1802.67 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 962.33 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 2005.98 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 2005.98 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 980.85, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 915.46, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 693.13, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1078.94, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 686.6, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 686.6, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1078.94, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 653.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 653.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 653.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 980.85, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "COCR FEM HD GT 280 OD+0", "code_information": [ { "code": "C1776", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 4588.1, "10th_percentile": 1617.12, "90th_percentile": 11630.3, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 9120.0, "10th_percentile": 9120.0, "90th_percentile": 9120.0, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 8640.0, "10th_percentile": 8640.0, "90th_percentile": 9120.0, "count": "1 through 10" } ] } ] }, { "description": "EXPRESS STENT 16MMX3.5MM", "code_information": [ { "code": "C1876", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 3100.8, "10th_percentile": 1880.29, "90th_percentile": 7522.24, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 3482.69, "10th_percentile": 3482.69, "90th_percentile": 3482.69, "count": "1 through 10" } ] } ] }, { "description": "TIBIAL INSERT FIXED LEFT SZ 5", "code_information": [ { "code": "C1776", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 4588.1, "10th_percentile": 1617.12, "90th_percentile": 11630.3, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 9120.0, "10th_percentile": 9120.0, "90th_percentile": 9120.0, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 8640.0, "10th_percentile": 8640.0, "90th_percentile": 9120.0, "count": "1 through 10" } ] } ] }, { "description": "APPENDECTOMY WITH COMPLEX PRINCIPAL DIAGNOSIS - SOI : 3", "code_information": [ { "code": "2333", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 23209.71, "maximum": 24602.29, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 24178.27 } ] } ] }, { "description": "MAJOR HEAD AND NECK PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "142", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 7429.4384, "maximum": 15304.6868, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 15251.7 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 15304.69 } ] } ] }, { "description": "CHEMILUMINESCENT ASSAY(REF)", "code_information": [ { "code": "82166", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 228.05, "discounted_cash": 43.0, "minimum": 33.5994, "maximum": 182.44, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 37.85, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 54.5 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 156.02 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 33.6 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 54.5 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 173.4 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 173.4 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 57.93, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 54.07, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 40.94, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 63.72, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 40.55, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 57.77 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 76.28 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.55, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 68.78 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 54.5 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 71.96 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 63.72, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "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": "fee schedule", "standard_charge_dollar": 52.91 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 38.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 38.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 46.34 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 57.93, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "MAJOR ESOPHAGEAL DISORDERS WITH MCC", "code_information": [ { "code": "368", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 8735.39, "maximum": 31525.2, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 8735.39 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 15261.55 } ] } ] }, { "description": "THROMBIN TIME", "code_information": [ { "code": "85670", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 40.0, "discounted_cash": 7.0, "minimum": 5.0199, "maximum": 165.84, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5.65, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.14 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 23.31 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5.02 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.14 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 25.91 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 25.91 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.66, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 8.08, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 6.12, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9.52, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 6.06, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.63 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.39 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.06, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 10.27 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.14 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.74 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.52, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.9 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 5.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 9.44 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.66, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "NONSPECIFIC CVA & PRECEREBRAL OCCLUSION WO INFARCT - SOI : 1", "code_information": [ { "code": "0461", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 10705.71, "maximum": 11348.05, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 11152.47 } ] } ] }, { "description": "STENT 27MX135M OD8MM", "code_information": [ { "code": "C1876", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 3100.8, "10th_percentile": 1880.29, "90th_percentile": 7522.24, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 3482.69, "10th_percentile": 3482.69, "90th_percentile": 3482.69, "count": "1 through 10" } ] } ] }, { "description": "CMV QUANT PLASMA PCR", "code_information": [ { "code": "87497", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 401.5, "discounted_cash": 76.0, "minimum": 30.5475, "maximum": 321.2, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 41.98, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 60.45 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 173.07 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 37.27 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 60.45 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 192.35 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 192.35 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 64.26, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 59.98, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 45.41, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 70.69, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 44.98, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 64.08 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 84.61 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 44.98, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 76.3 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 60.45 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 79.82 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 70.69, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "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": "fee schedule", "standard_charge_dollar": 58.69 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 76.29, "10th_percentile": 76.29, "90th_percentile": 76.29, "count": "1 through 10" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 42.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 42.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 70.13 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 64.26, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "CATH GUIDE 6FR XBLAD 4", "code_information": [ { "code": "C1887", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 115.24, "10th_percentile": 81.0, "90th_percentile": 503.66, "count": "23" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 156.51, "10th_percentile": 102.6, "90th_percentile": 572.45, "count": "11" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 129.36, "10th_percentile": 24.35, "90th_percentile": 512.12, "count": "1 through 10" } ] } ] }, { "description": "GUIDEWIRE MINI ACUTRAK", "code_information": [ { "code": "C1769", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 228.66, "10th_percentile": 43.17, "90th_percentile": 1333.19, "count": "49" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 200.16, "10th_percentile": 45.57, "90th_percentile": 746.52, "count": "29" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 130.22, "10th_percentile": 39.18, "90th_percentile": 442.41, "count": "15" } ] } ] }, { "description": "MED NUTRITION THERAPY PER 15M", "code_information": [ { "code": "97802", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 89.25, "discounted_cash": 16.0, "minimum": 13.3875, "maximum": 89.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 25.41, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 89.25 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 30.1 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 89.25 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 89.25 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 38.9, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 36.3, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 27.49, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 42.78, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 27.23, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.23, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 42.78, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 25.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 25.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 25.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 73.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 38.9, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "NEG PRESSURE WND THER<50 - 97605 - 970102", "code_information": [ { "code": "97605", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 406.7, "discounted_cash": 77.0, "minimum": 45.315, "maximum": 900.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 79.96, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 406.7 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 152.02 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 406.7 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 406.7 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 122.39, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 114.23, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 86.49, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 1895.25, "10th_percentile": 731.62, "90th_percentile": 2268.2, "count": "1 through 10" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 196.83, "10th_percentile": 108.48, "90th_percentile": 663.21, "count": "22" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 134.62, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 85.67, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.67, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 134.62, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 81.59, "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": 19.0, "median_amount": 196.83, "10th_percentile": 196.83, "90th_percentile": 196.83, "count": "1 through 10" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 81.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 81.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 186.47, "10th_percentile": 106.25, "90th_percentile": 196.83, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 122.39, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "FEMORAL TROCHLEA 20MM", "code_information": [ { "code": "C1776", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 4588.1, "10th_percentile": 1617.12, "90th_percentile": 11630.3, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 9120.0, "10th_percentile": 9120.0, "90th_percentile": 9120.0, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 8640.0, "10th_percentile": 8640.0, "90th_percentile": 9120.0, "count": "1 through 10" } ] } ] }, { "description": "HLTH BEHAVR IVNTJ INDIV F2-905", "code_information": [ { "code": "90834", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 354.0, "discounted_cash": 153.0, "minimum": 53.1, "maximum": 646.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 70.73, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 106.0 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 99.0 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 118.0 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 118.0 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 108.26, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 101.04, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 76.5, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 119.08, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 75.78, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 75.78, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange EPO/HMO", "methodology": "fee schedule", "standard_charge_dollar": 190.0 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 119.08, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 72.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 72.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 72.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "UBH Commercial", "methodology": "fee schedule", "standard_charge_dollar": 190.0 }, { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 130.0 }, { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicare", "methodology": "per diem", "standard_charge_dollar": 150.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 108.26, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "ELECT STIM UNATTEND FOR PRESS - G0281 - 970070", "code_information": [ { "code": "G0281", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 127.05, "minimum": 11.1622, "maximum": 116.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 39.08 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.55 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 43.4 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 43.4 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17.09, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 15.95, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 12.07, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.79, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 11.96, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.96, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.79, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 11.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 11.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.09, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "OPIOID ABUSE & DEPENDENCE - SOI : 4", "code_information": [ { "code": "7734", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 23288.02, "maximum": 24685.3, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 24259.85 } ] } ] }, { "description": "OTHER DISORDERS OF NERVOUS SYSTEM WITH CC", "code_information": [ { "code": "092", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 8101.72, "maximum": 22518.0, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 8101.72 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 9807.5 } ] } ] }, { "description": "Revisereplace knee joint", "code_information": [ { "code": "27486", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5633.91, "discounted_cash": 1070.0, "minimum": 845.0865, "maximum": 5633.91, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5116.57, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 1943.17 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 1037.33 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 2162.32 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 2162.32 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5633.91, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 5633.91, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 5534.25, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5633.91, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5482.04, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5482.04, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5633.91, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5220.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5220.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 5220.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5633.91, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "OTHER & UNSPECIFIED GASTROINTESTINAL HEMORRHAGE - SOI : 1", "code_information": [ { "code": "2531", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 6589.6, "maximum": 6984.97, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 6864.59 } ] } ] }, { "description": "UTERINE & ADNEXA PROCEDURES FOR NON-OVARIAN & NON-ADNEXAL MALIG - SOI : 2", "code_information": [ { "code": "5122", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 18245.54, "maximum": 19340.28, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 19006.95 } ] } ] }, { "description": "INFLAMMATORY BOWEL DISEASE - SOI : 4", "code_information": [ { "code": "2454", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 54512.2, "maximum": 57782.93, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 56787.05 } ] } ] }, { "description": "MINOR BLADDER PROCEDURES WITH CC", "code_information": [ { "code": "663", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 7365.2482, "maximum": 26271.0, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 11262.4 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 14574.16 } ] } ] }, { "description": "STENT INTEGRITY RX 4.0 X 12 MM", "code_information": [ { "code": "C1876", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 3100.8, "10th_percentile": 1880.29, "90th_percentile": 7522.24, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 3482.69, "10th_percentile": 3482.69, "90th_percentile": 3482.69, "count": "1 through 10" } ] } ] }, { "description": "NON-BACTERIAL INFECTIONS OF NERVOUS SYSTEM EXC VIRAL MENINGITIS - SOI : 4", "code_information": [ { "code": "0504", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 77380.01, "maximum": 82022.81, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 80609.15 } ] } ] }, { "description": "5.5 MM BIO CORKSCREW", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 168.56, "10th_percentile": 168.56, "90th_percentile": 168.56, "count": "1 through 10" } ] } ] }, { "description": "SCREW BONE CORTEX 3.5MMX24MM", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "CAROTID ANGIOGRAM UNILATERAL", "code_information": [ { "code": "36223", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 27028.5, "discounted_cash": 5135.0, "minimum": 2217.6028, "maximum": 21622.8, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2217.6, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 6112.93 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 3263.29 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 6802.36 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 6802.36 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3394.29, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 3168.0, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 2398.63, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 5135.42, "10th_percentile": 5135.42, "90th_percentile": 5135.42, "count": "1 through 10" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3733.72, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2376.0, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2376.0, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3733.72, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2262.86, "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": 19.0, "median_amount": 5135.42, "10th_percentile": 5135.42, "90th_percentile": 5135.42, "count": "1 through 10" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2262.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 2262.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3394.29, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "DIFFUSING CAPACITY", "code_information": [ { "code": "94729", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 491.43, "discounted_cash": 93.0, "minimum": 40.7595, "maximum": 393.144, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 126.96 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 40.76 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 141.02 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 141.02 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 334.17, "10th_percentile": 334.17, "90th_percentile": 334.17, "count": "1 through 10" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 88.46, "10th_percentile": 88.46, "90th_percentile": 95.34, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 93.37, "10th_percentile": 93.37, "90th_percentile": 93.37, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 88.46, "10th_percentile": 88.46, "90th_percentile": 88.46, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 276.0 } ] } ] }, { "description": "SCREW 5.0 X 35MM CANNULATED", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "SCREW COMPRESSION SHORT 2.4X17", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "CATH COURNAND RT HT6", "code_information": [ { "code": "C1887", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 115.24, "10th_percentile": 81.0, "90th_percentile": 503.66, "count": "23" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 156.51, "10th_percentile": 102.6, "90th_percentile": 572.45, "count": "11" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 129.36, "10th_percentile": 24.35, "90th_percentile": 512.12, "count": "1 through 10" } ] } ] }, { "description": "BIDIRECTIONAL TORQUE WRE", "code_information": [ { "code": "C1769", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 228.66, "10th_percentile": 43.17, "90th_percentile": 1333.19, "count": "49" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 200.16, "10th_percentile": 45.57, "90th_percentile": 746.52, "count": "29" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 130.22, "10th_percentile": 39.18, "90th_percentile": 442.41, "count": "15" } ] } ] }, { "description": "MONORAIL STENT 24MMX3.5", "code_information": [ { "code": "C1876", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 3100.8, "10th_percentile": 1880.29, "90th_percentile": 7522.24, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 3482.69, "10th_percentile": 3482.69, "90th_percentile": 3482.69, "count": "1 through 10" } ] } ] }, { "description": "ION MONORAIL STENT 3.5X32MM", "code_information": [ { "code": "C1876", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 3100.8, "10th_percentile": 1880.29, "90th_percentile": 7522.24, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 3482.69, "10th_percentile": 3482.69, "90th_percentile": 3482.69, "count": "1 through 10" } ] } ] }, { "description": "OTHER MAJOR CARDIOVASCULAR PROCEDURES WITH MCC", "code_information": [ { "code": "270", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 3123.02, "maximum": 50583.8881, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 3123.02 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 50583.89 } ] } ] }, { "description": "24 HOUR URINE CALCULATION", "code_information": [ { "code": "81050", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 18.2, "discounted_cash": 3.0, "minimum": 2.73, "maximum": 16.34, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3.57, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.14 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 14.71 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3.17 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.14 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 16.34 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 16.34 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5.46, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 5.1, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 3.86, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.01, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3.82, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.45 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.19 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.82, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 6.49 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.14 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.79 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.01, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.99 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 3.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 4.91 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5.46, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "MAJOR DEPRESSIVE DISORDERS & OTHERUNSPECIFIED PSYCHOSES - SOI : 3", "code_information": [ { "code": "7513", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 7202.72, "maximum": 7634.88, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 7503.29 } ] } ] }, { "description": "STRAPPING OF KNEE - 29530 - 964611", "code_information": [ { "code": "29530", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 493.75, "discounted_cash": 93.0, "minimum": 45.9825, "maximum": 395.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 53.02, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 145.01 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 77.41 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 161.36 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 161.36 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 81.15, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 75.74, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 57.35, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 71.1, "10th_percentile": 71.1, "90th_percentile": 71.1, "count": "1 through 10" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 89.27, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 56.81, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 56.81, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 24.6, "median_amount": 101.12, "10th_percentile": 101.12, "90th_percentile": 268.6, "count": "1 through 10" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 89.27, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 54.1, "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": 19.0, "median_amount": 75.05, "10th_percentile": 75.05, "90th_percentile": 75.05, "count": "1 through 10" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 54.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 54.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 84.29, "10th_percentile": 84.29, "90th_percentile": 84.29, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 81.15, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "CHORIONIC GUNADOSTROPIN(REF)", "code_information": [ { "code": "84702", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 38.03, "discounted_cash": 7.0, "minimum": 5.7045, "maximum": 259.6, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14.75, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.24 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 38.03 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 13.09 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.24 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 38.03 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 38.03 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.58, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 21.07, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 15.95, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 24.83, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 15.8, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.51 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 29.73 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.8, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange EPO/HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 27.55, "median_amount": 12.64, "10th_percentile": 12.64, "90th_percentile": 12.64, "count": "1 through 10" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 26.81 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.24 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28.04 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 24.83, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.62 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 24.65 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 22.58, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "SCREW VARIABLE ANGLE 5.0X36MM", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "LANOXIN", "drug_information": { "unit": 2.0, "type": "ML" }, "code_information": [ { "code": "70515026110", "type": "NDC" }, { "code": "J1160", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 244.52, "10th_percentile": 244.52, "90th_percentile": 244.52, "count": "1 through 10" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 24.6, "median_amount": 19.5, "10th_percentile": 19.5, "90th_percentile": 19.5, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 217.71, "10th_percentile": 217.71, "90th_percentile": 217.71, "count": "1 through 10" } ] } ] }, { "description": "NAIL TFN 11X440MM FEM RT", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "SCREW BONE 4/5MM 1.35MM", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "Giardia", "code_information": [ { "code": "87328", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 57.87, "discounted_cash": 10.0, "minimum": 8.6805, "maximum": 57.87, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13.54, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.5 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 55.83 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.02 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.5 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 57.87 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 57.87 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 20.73, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 19.35, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 14.65, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 22.8, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 14.51, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.67 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.29 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.51, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 24.61 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.5 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.74 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 22.8, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 13.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.93 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 13.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 19.63 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 20.73, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "PSA ULTRASENSITIVE WO SERIAL L", "code_information": [ { "code": "84153", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 123.64, "discounted_cash": 19.0, "minimum": 15.1725, "maximum": 187.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 75.0, "median_amount": 84.3, "10th_percentile": 84.3, "90th_percentile": 84.3, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.02, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.95 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 74.3 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 16.0 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.95 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 82.57 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 82.57 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 130.9, "10th_percentile": 22.92, "90th_percentile": 158.95, "count": "1 through 10" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 27.59, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 25.75, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 19.49, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 18.21, "10th_percentile": 8.78, "90th_percentile": 45.35, "count": "1 through 10" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 30.34, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 19.31, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.5 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 36.31 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.31, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 32.75 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.95 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 34.26 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 30.34, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 18.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.19 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 23.49, "10th_percentile": 19.22, "90th_percentile": 44.41, "count": "18" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 18.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 23.49, "10th_percentile": 18.21, "90th_percentile": 42.08, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 30.11 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 27.59, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "CATH MULTI A-2 7FHF", "code_information": [ { "code": "C1887", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 115.24, "10th_percentile": 81.0, "90th_percentile": 503.66, "count": "23" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 156.51, "10th_percentile": 102.6, "90th_percentile": 572.45, "count": "11" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 129.36, "10th_percentile": 24.35, "90th_percentile": 512.12, "count": "1 through 10" } ] } ] }, { "description": "SCREW CORTICLE 3.5X12MM", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "XR CALCANEUS 2+V-LT", "code_information": [ { "code": "73650", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 491.65, "discounted_cash": 93.0, "minimum": 34.6822, "maximum": 393.32, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 34.68, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 112.36 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 322.43 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 69.43 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 112.36 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 358.35 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 358.35 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 53.09, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 49.55, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 37.51, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 104.92, "10th_percentile": 104.92, "90th_percentile": 104.92, "count": "1 through 10" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 58.39, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 37.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 119.1 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 157.26 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 37.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 141.82 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 112.36 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 148.36 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 58.39, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 35.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 109.09 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 35.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 35.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 68.82 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 53.09, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "17 HYDROXYCORT (17OH)", "code_information": [ { "code": "83491", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 197.0, "discounted_cash": 37.0, "minimum": 15.573, "maximum": 157.6, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17.54, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.26 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 72.32 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 15.57 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.26 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 80.37 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 80.37 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 26.85, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 25.06, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 18.97, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 29.54, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 18.8, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26.77 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 35.35 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.8, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 31.88 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.26 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 33.35 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 29.54, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 17.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.52 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 17.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 17.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 28.68 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 26.85, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "MAJOR RESPIRATORY INFECTIONS & INFLAMMATIONS - SOI : 4", "code_information": [ { "code": "1374", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 29715.26, "maximum": 31498.18, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 30955.31 } ] } ] }, { "description": "THIOTHIXENE NAVANE", "code_information": [ { "code": "80299", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 179.0, "discounted_cash": 34.0, "minimum": 3.0, "maximum": 340.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.27, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26.31 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 75.31 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 16.22 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26.31 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 83.69 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 83.69 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 27.96, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 26.1, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 19.76, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 87.74, "10th_percentile": 52.01, "90th_percentile": 104.02, "count": "1 through 10" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 30.76, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 19.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.88 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 36.82 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 33.2 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26.31 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 34.73 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 30.76, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 18.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.54 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 18.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 104.02, "10th_percentile": 104.02, "90th_percentile": 104.02, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 22.42 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 27.96, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "LOVENOX - 00075062430", "drug_information": { "unit": 0.3, "type": "ML" }, "code_information": [ { "code": "00075062430", "type": "NDC" }, { "code": "J1650", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 53.96, "10th_percentile": 44.44, "90th_percentile": 53.96, "count": "1 through 10" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 15.08, "10th_percentile": 12.7, "90th_percentile": 33.92, "count": "61" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 24.6, "median_amount": 6.31, "10th_percentile": 2.31, "90th_percentile": 15.78, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 15.08, "10th_percentile": 15.08, "90th_percentile": 30.2, "count": "34" } ] } ] }, { "description": "MYELO L/S", "code_information": [ { "code": "72265", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3108.52, "discounted_cash": 590.0, "minimum": 312.4142, "maximum": 3056.88, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 312.41, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 990.07 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 2750.51 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 592.31 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 990.07 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 3056.88 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 3056.88 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 478.19, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 446.31, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 337.92, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 526.0, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 334.73, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1049.47 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1385.71 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 334.73, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 1249.6 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 990.07 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1307.27 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 526.0, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 318.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 961.23 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 318.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 318.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 716.89 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 478.19, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "FRACTURES OF HIP AND PELVIS WITH MCC", "code_information": [ { "code": "535", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 5697.6884, "maximum": 29273.4, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 12623.8 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 12290.53 } ] } ] }, { "description": "ANTIGEN TYPING EA", "code_information": [ { "code": "86905", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 109.68, "discounted_cash": 17.0, "minimum": 5.25, "maximum": 109.68, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 109.68, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.41 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 109.68 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 109.68 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.41 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 109.68 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 109.68 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 109.68, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 109.68, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 109.68, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 109.68, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 109.68, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.73 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.57 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 109.68, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 6.83 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.41 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.14 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 109.68, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 109.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.25 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 109.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 109.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 6.26 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 109.68, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "CATH DILATION TRAK 2.5X15", "code_information": [ { "code": "C1725", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 462.76, "10th_percentile": 256.45, "90th_percentile": 2515.23, "count": "21" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 270.69, "10th_percentile": 106.59, "90th_percentile": 1342.29, "count": "14" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 484.0, "10th_percentile": 143.56, "90th_percentile": 543.74, "count": "1 through 10" } ] } ] }, { "description": "Sacro-iliac S3 Rhizotomy", "code_information": [ { "code": "64640", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2253.26, "discounted_cash": 160.0, "minimum": 125.3, "maximum": 1802.608, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 352.49, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 169.42 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 125.3 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 188.83 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 188.83 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 539.52, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 503.55, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 381.26, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 593.47, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 377.66, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 377.66, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 593.47, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 359.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 359.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 359.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 539.52, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "MALFUNCTION, REACTION & COMPLICATION OF GI DEVICE OR PROCEDURE - SOI : 4", "code_information": [ { "code": "2524", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 45766.18, "maximum": 48512.15, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 47676.05 } ] } ] }, { "description": "RUBELLA IGG", "code_information": [ { "code": "86762", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 140.0, "discounted_cash": 26.0, "minimum": 12.5193, "maximum": 112.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14.1, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.3 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 58.14 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.52 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.3 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 64.61 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 64.61 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 21.59, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 20.15, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 15.25, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 23.74, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 15.11, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.52 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28.41 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.11, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 25.62 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.3 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26.81 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 23.74, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 14.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.71 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 14.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 23.57 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.59, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "VAGINAL DELIVERY - SOI : 2", "code_information": [ { "code": "5602", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 4075.04, "maximum": 5953.72, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 5953.72 } ] } ] }, { "description": "FEMALE REPRODUCTIVE SYSTEM MALIGNANCY - SOI : 2", "code_information": [ { "code": "5302", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 10216.74, "maximum": 10829.74, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 10643.09 } ] } ] }, { "description": "CD4 HELPER INDUCER FC(REF)", "code_information": [ { "code": "88182", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 521.25, "discounted_cash": 99.0, "minimum": 20.7662, "maximum": 417.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 20.77, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 199.86 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 43.04 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 222.12 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 222.12 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 31.79, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 29.67, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 22.46, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 34.96, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 22.25, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.25, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 34.96, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 21.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 21.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 21.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 43.84 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 31.79, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "STENT XIENCE SIERRA 4.0X18MM", "code_information": [ { "code": "C1874", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 4258.8, "10th_percentile": 4258.8, "90th_percentile": 4420.0, "count": "1 through 10" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1456.46, "10th_percentile": 975.0, "90th_percentile": 4680.0, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1444.95, "10th_percentile": 1444.95, "90th_percentile": 1444.95, "count": "1 through 10" } ] } ] }, { "description": "CIPRO 400MG/200ML", "drug_information": { "unit": 200.0, "type": "ML" }, "code_information": [ { "code": "36000000924", "type": "NDC" }, { "code": "J0744", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 19.04, "10th_percentile": 19.04, "90th_percentile": 19.04, "count": "1 through 10" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 10.08, "10th_percentile": 5.04, "90th_percentile": 23.9, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 5.32, "10th_percentile": 5.32, "90th_percentile": 12.69, "count": "1 through 10" } ] } ] }, { "description": "FETAL SCREEN (ROSETTE)", "code_information": [ { "code": "85461", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 159.38, "discounted_cash": 30.0, "minimum": 8.1432, "maximum": 127.504, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.17, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.21 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 37.81 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 8.14 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.21 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 42.03 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 42.03 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14.04, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 13.1, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 9.92, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15.44, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 9.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.01 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.5 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 16.68 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.21 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.45 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.44, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 9.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.83 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 9.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 9.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 10.86 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.04, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "Wound Eval-Mod Risk - G0463 - 487026", "code_information": [ { "code": "G0463", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 324.0, "minimum": 48.6, "maximum": 324.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 53.05, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 314.17 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 100.86 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 324.0 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 324.0 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 81.2, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 75.78, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 57.38, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 89.31, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 56.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 56.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 89.31, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 54.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 54.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 54.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 79.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 81.2, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "MAJOR RESPIRATORY & CHEST PROCEDURES - SOI : 1", "code_information": [ { "code": "1201", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 22566.03, "maximum": 23919.99, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 23507.73 } ] } ] }, { "description": "ESOPHAGITIS, GASTROENTERITIS AND MISCELLANEOUS DIGESTIVE DISORDERS WITHOUT MCC", "code_information": [ { "code": "392", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 3529.9992, "maximum": 18765.0, "payers_information": [ { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "other", "standard_charge_dollar": 11250.0, "standard_charge_algorithm": "$4,500 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 9000.0, "10th_percentile": 9000.0, "90th_percentile": 13500.0, "count": "1 through 10" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 5514.88 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 7474.03 } ] } ] }, { "description": "CONTR NOSEBLEED ANT SIMPLE", "code_information": [ { "code": "30901", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 672.03, "discounted_cash": 127.0, "minimum": 53.018, "maximum": 537.624, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 53.02, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 145.01 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 77.41 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 161.36 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 161.36 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 81.15, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 75.74, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 57.35, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 389.13, "10th_percentile": 122.38, "90th_percentile": 625.12, "count": "1 through 10" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 89.27, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 56.81, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 56.81, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 89.27, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 54.1, "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": 19.0, "median_amount": 127.69, "10th_percentile": 127.69, "90th_percentile": 127.69, "count": "1 through 10" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 54.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 54.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 81.15, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "PERINUCLEAR (P-ANCA) LC", "code_information": [ { "code": "86256", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 37.05, "discounted_cash": 7.0, "minimum": 5.0445, "maximum": 124.256, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11.81, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.01 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 37.05 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 10.48 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.01 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 37.05 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 37.05 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 86.98, "10th_percentile": 62.24, "90th_percentile": 105.62, "count": "1 through 10" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.08, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 12.77, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 30.13, "10th_percentile": 12.05, "90th_percentile": 30.13, "count": "1 through 10" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.88, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.03 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.8 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 21.46 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.01 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.45 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.88, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.51 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 29.51, "10th_percentile": 29.51, "90th_percentile": 29.51, "count": "1 through 10" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 19.73 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.08, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "WEDGE EXC SKIN NAIL FOLD", "code_information": [ { "code": "11765", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 932.4, "discounted_cash": 177.0, "minimum": 139.86, "maximum": 745.92, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 162.0, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 424.95 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 226.85 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 472.87 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 472.87 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 247.97, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 231.43, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 175.23, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 272.76, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 173.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 272.76, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 165.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 165.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 165.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 247.97, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "SCREW HEADLESS LT-55 4.5 TI", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "COR STENT 3MX12 TAXUS", "code_information": [ { "code": "C1874", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 4258.8, "10th_percentile": 4258.8, "90th_percentile": 4420.0, "count": "1 through 10" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1456.46, "10th_percentile": 975.0, "90th_percentile": 4680.0, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1444.95, "10th_percentile": 1444.95, "90th_percentile": 1444.95, "count": "1 through 10" } ] } ] }, { "description": "ASSAY OF PHENYTOIN FREE", "code_information": [ { "code": "80186", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 198.0, "discounted_cash": 37.0, "minimum": 11.9712, "maximum": 158.4, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13.48, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.42 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 55.59 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 11.97 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.42 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 61.78 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 61.78 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 20.64, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 19.26, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 14.59, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 22.7, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 14.45, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.58 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.17 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.45, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 24.51 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.42 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.64 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 22.7, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 13.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.85 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 13.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 22.54 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 20.64, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "NEONATE W ECMO - SOI : 2", "code_information": [ { "code": "5832", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 306039.01, "maximum": 324401.35, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 318810.31 } ] } ] }, { "description": "CRTX SCRW 4.5MM X 34MM", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "RMVL DEVITAL TIS ADDL 20CM/<(M", "code_information": [ { "code": "97598", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 417.36, "discounted_cash": 79.0, "minimum": 10.0311, "maximum": 608.0, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 31.25 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 10.03 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 34.71 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 34.71 } ] } ] }, { "description": "GEN PROBE", "code_information": [ { "code": "87490", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 28.0, "discounted_cash": 5.0, "minimum": 4.2, "maximum": 28.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.3, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28.0 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 28.0 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 19.79 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28.0 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 28.0 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 28.0 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 28.0, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 28.0, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 24.12, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 28.0, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 23.89, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28.0 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28.0 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.89, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 28.0 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28.0 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28.0 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 28.0, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 22.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28.0 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 22.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 22.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 28.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 28.0, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "RPLCMT COMPL PRPH CVC WO PP", "code_information": [ { "code": "36584", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2964.0, "discounted_cash": 592.0, "minimum": 444.6, "maximum": 2493.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 627.35, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 2169.4 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 1158.1 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 2414.07 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 2414.07 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 960.23, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 896.21, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 678.56, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1056.25, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 672.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 672.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1056.25, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 640.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 640.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 640.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 960.23, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "US ABDOMEN SPLEEN", "code_information": [ { "code": "76705", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 787.11, "discounted_cash": 186.0, "minimum": 41.6598, "maximum": 866.8, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 75.0, "median_amount": 737.92, "10th_percentile": 737.92, "90th_percentile": 811.71, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 41.66, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 135.95 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 452.8 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 97.51 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 135.95 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 503.24 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 503.24 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 669.05, "10th_percentile": 606.08, "90th_percentile": 735.95, "count": "27" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 63.77, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 59.51, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 45.06, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 324.68, "10th_percentile": 324.68, "90th_percentile": 325.05, "count": "11" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 210.2, "10th_percentile": 194.81, "90th_percentile": 231.22, "count": "39" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 70.14, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 44.64, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 144.11 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 190.28 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 44.64, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 171.59 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 135.95 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 179.51 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 70.14, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 42.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 131.99 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 205.63, "10th_percentile": 205.63, "90th_percentile": 205.87, "count": "20" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 42.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 42.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 205.63, "10th_percentile": 194.81, "90th_percentile": 230.96, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 161.48 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 63.77, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "Laparo cholecystectomy/graph", "code_information": [ { "code": "47563", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8507.68, "discounted_cash": 1616.0, "minimum": 1276.152, "maximum": 7153.89, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2409.3, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 6428.83 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 3431.93 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 7153.89 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 7153.89 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 3004.75, "10th_percentile": 1802.85, "90th_percentile": 12750.0, "count": "1 through 10" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3687.71, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 3441.86, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 2605.98, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 3976.88, "10th_percentile": 3976.88, "90th_percentile": 5400.0, "count": "1 through 10" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4056.48, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2581.39, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2581.39, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4056.48, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2458.47, "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": 19.0, "median_amount": 7125.0, "10th_percentile": 7125.0, "90th_percentile": 7125.0, "count": "1 through 10" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2458.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 2458.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3687.71, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "SCREW CANNULATED 70MM", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "MAJOR SMALL BOWEL PROCEDURES - SOI : 3", "code_information": [ { "code": "2303", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 37121.39, "maximum": 39348.68, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 38670.51 } ] } ] }, { "description": "EXC ARMELBOW LES SC < 3 CM", "code_information": [ { "code": "24075", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 11250.0, "discounted_cash": 2137.0, "minimum": 658.1974, "maximum": 9000.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 658.2, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 1825.56 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 974.55 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 2031.45 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 2031.45 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1007.45, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 940.28, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 711.93, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1108.19, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 705.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 705.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1108.19, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 671.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 671.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 671.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1007.45, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "STENT RESOLUTE RX 3.0X34MM", "code_information": [ { "code": "C1876", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 3100.8, "10th_percentile": 1880.29, "90th_percentile": 7522.24, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 3482.69, "10th_percentile": 3482.69, "90th_percentile": 3482.69, "count": "1 through 10" } ] } ] }, { "description": "SCREW COMPRESSION/HEADLESS 2.5", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "POST-OPERATIVE, POST-TRAUMATIC, OTHER DEVICE INFECTIONS - SOI : 4", "code_information": [ { "code": "7214", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 37044.99, "maximum": 39267.69, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 38590.92 } ] } ] }, { "description": "SCREW CANCELLOUS 4X18 M", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "CENTRAL LINE INSERTION - 36556 - 964654", "code_information": [ { "code": "36556", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 14308.3, "discounted_cash": 566.0, "minimum": 447.537, "maximum": 13127.76, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1258.34, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 2169.4 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 1158.1 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 2414.07 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 2414.07 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1926.03, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 1797.63, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 1361.06, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2118.63, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1348.22, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1348.22, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2118.63, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1284.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1284.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 1284.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1926.03, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "CATH EUPHORA RX 4.0X20MM - C1725 - 900605", "code_information": [ { "code": "C1725", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 462.76, "10th_percentile": 256.45, "90th_percentile": 2515.23, "count": "21" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 270.69, "10th_percentile": 106.59, "90th_percentile": 1342.29, "count": "14" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 484.0, "10th_percentile": 143.56, "90th_percentile": 543.74, "count": "1 through 10" } ] } ] }, { "description": "STENT ONYX FRONTIER 3.0X18MM", "code_information": [ { "code": "C1874", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 4258.8, "10th_percentile": 4258.8, "90th_percentile": 4420.0, "count": "1 through 10" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1456.46, "10th_percentile": 975.0, "90th_percentile": 4680.0, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1444.95, "10th_percentile": 1444.95, "90th_percentile": 1444.95, "count": "1 through 10" } ] } ] }, { "description": "BLEEDING TIME", "code_information": [ { "code": "85002", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 130.25, "discounted_cash": 24.0, "minimum": 4.1934, "maximum": 104.2, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4.72, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.8 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 19.47 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 4.19 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.8 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 21.64 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 21.64 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7.23, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 6.75, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 5.11, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.95, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5.06, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.21 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.51 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.06, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 8.58 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.8 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.98 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.95, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 4.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.6 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 4.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 7.38 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.23, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "IMMUNIZATION EA ADDL", "code_information": [ { "code": "90472", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 26.25, "discounted_cash": 4.0, "minimum": 3.9375, "maximum": 68.8, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 26.25 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 11.28 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 26.25 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 26.25 } ] } ] }, { "description": "EVERCROSS BALLOON 3MM X 40MM", "code_information": [ { "code": "C1725", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 462.76, "10th_percentile": 256.45, "90th_percentile": 2515.23, "count": "21" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 270.69, "10th_percentile": 106.59, "90th_percentile": 1342.29, "count": "14" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 484.0, "10th_percentile": 143.56, "90th_percentile": 543.74, "count": "1 through 10" } ] } ] }, { "description": "OT ESTIM MANUAL 15 MIN", "code_information": [ { "code": "97032", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 169.13, "discounted_cash": 32.0, "minimum": 13.1718, "maximum": 135.304, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14.07, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 41.03 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 13.17 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 45.57 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 45.57 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 21.54, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 20.1, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 15.22, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 23.69, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 23.69, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 14.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 14.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 79.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.54, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON WITH MCC", "code_information": [ { "code": "268", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 12903.4, "maximum": 65938.4273, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 12903.4 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 65938.43 } ] } ] }, { "description": "UPPER LIMB AND TOE AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS WITH CC", "code_information": [ { "code": "256", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 7587.8358, "maximum": 37530.0, "payers_information": [ { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "other", "standard_charge_dollar": 22500.0, "standard_charge_algorithm": "$4,500 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 13500.0, "10th_percentile": 13500.0, "90th_percentile": 13500.0, "count": "1 through 10" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 16076.9 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 16277.77 } ] } ] }, { "description": "AMPUTATION OF LOWER LIMB FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITHOUT CCMCC", "code_information": [ { "code": "618", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 6017.254, "maximum": 31525.2, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 11819.1 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 13597.24 } ] } ] }, { "description": "CANC SCREW 2333-110", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "RESP SYNC VIRUS AG EIA", "code_information": [ { "code": "87807", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 277.5, "discounted_cash": 52.0, "minimum": 11.397, "maximum": 222.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12.84, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.49 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 52.92 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 11.4 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.49 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 58.82 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 58.82 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 188.7, "10th_percentile": 155.4, "90th_percentile": 188.7, "count": "1 through 10" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.65, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 18.34, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 13.89, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.62, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 13.76, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.6 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.88 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.76, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 23.34 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.49 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.41 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.62, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 13.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.95 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 13.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 19.63 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.65, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "NON-EXTENSIVE OR PROCEDURES FOR OTHER COMPLICATIONS OF TREATMENT - SOI : 1", "code_information": [ { "code": "7941", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 7196.03, "maximum": 7627.79, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 7496.33 } ] } ] }, { "description": "HEART &OR LUNG TRANSPLANT - SOI : 4", "code_information": [ { "code": "0024", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 590837.56, "maximum": 626287.81, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 615493.77 } ] } ] }, { "description": "PACEMAKER DISCOVERY SR", "code_information": [ { "code": "C1786", "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": 19.0, "median_amount": 4220.28, "10th_percentile": 4220.28, "90th_percentile": 4220.28, "count": "1 through 10" } ] } ] }, { "description": "OTHER MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE DIAGNOSES - SOI : 1", "code_information": [ { "code": "3511", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 7643.93, "maximum": 8102.57, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 7962.92 } ] } ] }, { "description": "LEAD URINE", "code_information": [ { "code": "83655", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 103.22, "discounted_cash": 19.0, "minimum": 10.5357, "maximum": 103.224, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11.87, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.09 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 48.92 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 10.54 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.09 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 54.37 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 54.37 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 72.26, "10th_percentile": 72.26, "90th_percentile": 72.26, "count": "1 through 10" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.17, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 16.95, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 12.84, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.98, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.72, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.11 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.92 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.72, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 21.57 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.09 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.56 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.98, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "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": "fee schedule", "standard_charge_dollar": 16.59 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 19.82 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.17, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "Rerepair ing hernia reduce", "code_information": [ { "code": "49520", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7070.0, "discounted_cash": 1343.0, "minimum": 1060.5, "maximum": 5656.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1426.89, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 4135.42 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 2207.63 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 4601.82 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 4601.82 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2184.02, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 2038.41, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 1543.37, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2402.42, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1528.81, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1528.81, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2402.42, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1456.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1456.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 1456.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2184.02, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "TX/PROPH/DG ADDL SEQ IV INF-MS", "code_information": [ { "code": "96367", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 337.32, "discounted_cash": 50.0, "minimum": 27.5877, "maximum": 3535.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 28.69, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 85.93 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 27.59 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 95.45 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 95.45 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 43.92, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 40.99, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 31.04, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 70.87, "10th_percentile": 60.72, "90th_percentile": 337.32, "count": "41" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 48.31, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 30.74, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30.74, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 48.31, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 29.28, "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": 19.0, "median_amount": 64.09, "10th_percentile": 64.09, "90th_percentile": 128.18, "count": "11" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 29.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 29.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 64.09, "10th_percentile": 60.72, "90th_percentile": 128.18, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 337.32 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 43.92, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "STENT ONYX FRONTIER 4.0X12MM", "code_information": [ { "code": "C1874", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 4258.8, "10th_percentile": 4258.8, "90th_percentile": 4420.0, "count": "1 through 10" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1456.46, "10th_percentile": 975.0, "90th_percentile": 4680.0, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1444.95, "10th_percentile": 1444.95, "90th_percentile": 1444.95, "count": "1 through 10" } ] } ] }, { "description": "UTERINE & ADNEXA PROCEDURES FOR LEIOMYOMA - SOI : 2", "code_information": [ { "code": "5192", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 12355.02, "maximum": 13096.32, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 12870.6 } ] } ] }, { "description": "DUP VEIN BIL", "code_information": [ { "code": "93970", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1795.51, "discounted_cash": 341.0, "minimum": 95.0796, "maximum": 1481.0, "payers_information": [ { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 145.53, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 135.83, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 102.84, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 538.65, "10th_percentile": 538.65, "90th_percentile": 538.65, "count": "1 through 10" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 348.33, "10th_percentile": 323.19, "90th_percentile": 383.16, "count": "33" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 160.08, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 101.87, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 332.53 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 439.07 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 101.87, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 395.94 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 313.71 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 414.22 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 160.08, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 97.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 304.57 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 341.15, "10th_percentile": 341.15, "90th_percentile": 341.15, "count": "30" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 97.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 97.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 341.15, "10th_percentile": 341.15, "90th_percentile": 383.16, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 781.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 145.53, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 95.08, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 313.71 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 443.41 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 142.35 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 313.71 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 492.5 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 492.5 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 1109.95, "10th_percentile": 1005.49, "90th_percentile": 1220.95, "count": "1 through 10" } ] } ] }, { "description": "GAMMA NAIL SCREW 6.28X40", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "HA COATED POROUS HIP", "code_information": [ { "code": "C1776", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 4588.1, "10th_percentile": 1617.12, "90th_percentile": 11630.3, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 9120.0, "10th_percentile": 9120.0, "90th_percentile": 9120.0, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 8640.0, "10th_percentile": 8640.0, "90th_percentile": 9120.0, "count": "1 through 10" } ] } ] }, { "description": "CATH EUPHORA 3.5MM X 12MM", "code_information": [ { "code": "C1725", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 462.76, "10th_percentile": 256.45, "90th_percentile": 2515.23, "count": "21" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 270.69, "10th_percentile": 106.59, "90th_percentile": 1342.29, "count": "14" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 484.0, "10th_percentile": 143.56, "90th_percentile": 543.74, "count": "1 through 10" } ] } ] }, { "description": "FRACTURES OF FEMUR WITHOUT MCC", "code_information": [ { "code": "534", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 3641.7548, "maximum": 21767.4, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 4439.96 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 7728.08 } ] } ] }, { "description": "STENT VIABAHN 7X10CM", "code_information": [ { "code": "C1874", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 4258.8, "10th_percentile": 4258.8, "90th_percentile": 4420.0, "count": "1 through 10" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1456.46, "10th_percentile": 975.0, "90th_percentile": 4680.0, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1444.95, "10th_percentile": 1444.95, "90th_percentile": 1444.95, "count": "1 through 10" } ] } ] }, { "description": "CORONARY BYPASS WITHOUT CARDIAC CATHETERIZATION WITHOUT MCC", "code_information": [ { "code": "236", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 18845.1344, "maximum": 43534.8, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 41796.5 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 40158.03 } ] } ] }, { "description": "IRON BINDING (TIBC)", "code_information": [ { "code": "83550", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 181.5, "discounted_cash": 34.0, "minimum": 7.6038, "maximum": 145.2, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.57, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.33 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 35.31 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 7.6 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.33 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 39.24 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 39.24 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 123.42, "10th_percentile": 101.64, "90th_percentile": 123.42, "count": "21" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13.11, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 12.24, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 9.26, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 34.49, "10th_percentile": 8.74, "90th_percentile": 38.73, "count": "26" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.42, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 9.18, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.07 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.26 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.18, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 15.56 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.33 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.28 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.42, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 8.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.97 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 34.49, "10th_percentile": 34.49, "90th_percentile": 34.49, "count": "22" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 8.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 35.21, "10th_percentile": 32.67, "90th_percentile": 38.73, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 14.32 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 13.11, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "CARDIAC DEFIBRILLATOR IMPLANT WITH CARDIAC CATHETERIZATION AND MCC", "code_information": [ { "code": "275", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 37350.0, "maximum": 68359.1448, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 55687.6 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 68359.14 } ] } ] }, { "description": "NDSC NJX IMPLT MATRL URT&/BLDR", "code_information": [ { "code": "51715", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6783.1, "discounted_cash": 1288.0, "minimum": 1017.465, "maximum": 5426.48, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1404.8, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 4014.66 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 2143.16 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 4467.44 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 4467.44 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2150.21, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 2006.86, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 1519.48, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2365.23, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1505.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1505.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2365.23, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1433.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1433.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 1433.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2150.21, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "B-Hydroxybutyrate", "code_information": [ { "code": "82010", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 208.25, "discounted_cash": 39.0, "minimum": 7.1079, "maximum": 257.4, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.01, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.53 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 33.01 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 7.11 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.53 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 36.68 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 36.68 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12.26, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 11.44, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 8.66, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 39.57, "10th_percentile": 39.57, "90th_percentile": 39.57, "count": "1 through 10" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 13.48, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 8.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.22 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.13 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 14.55 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.53 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.22 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.48, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 8.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.19 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 8.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 13.38 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.26, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "BNE WCREW 3.5MX36M LCP", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "TRICHOMONAS VAGINALIS NAA LC - 87799 - 800276", "code_information": [ { "code": "87799", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 375.0, "discounted_cash": 71.0, "minimum": 37.2708, "maximum": 576.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 41.98, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 60.45 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 173.07 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 37.27 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 60.45 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 192.35 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 192.35 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 64.26, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 59.98, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 45.41, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 70.69, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 44.98, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 64.08 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 84.61 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 44.98, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 76.3 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 60.45 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 79.82 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 70.69, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "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": "fee schedule", "standard_charge_dollar": 58.69 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 52.25, "10th_percentile": 52.25, "90th_percentile": 52.25, "count": "1 through 10" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 42.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 42.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 70.13 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 64.26, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "CATH EVERCROSS EV3 6X100MM", "code_information": [ { "code": "C1725", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 462.76, "10th_percentile": 256.45, "90th_percentile": 2515.23, "count": "21" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 270.69, "10th_percentile": 106.59, "90th_percentile": 1342.29, "count": "14" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 484.0, "10th_percentile": 143.56, "90th_percentile": 543.74, "count": "1 through 10" } ] } ] }, { "description": "PROSTATECTOMY WITH CC", "code_information": [ { "code": "666", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 8008.9974, "maximum": 27021.6, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 15636.5 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 16770.54 } ] } ] }, { "description": "PLETHYSMOGRAM", "code_information": [ { "code": "94726", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 320.19, "discounted_cash": 60.0, "minimum": 48.0285, "maximum": 320.19, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 148.71, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 320.19 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 220.2 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 320.19 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 320.19 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 227.61, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 212.44, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 160.84, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 250.37, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 159.33, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 159.33, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 250.37, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 151.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 151.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 151.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 276.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 227.61, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "NON-ELECTIVE OR COMPLEX HIP JOINT REPLACEMENT- SOI : 3", "code_information": [ { "code": "3233", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 30272.99, "maximum": 32089.37, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 31536.31 } ] } ] }, { "description": "MAJOR GASTROINTESTINAL DISORDERS AND PERITONEAL INFECTIONS WITH CC", "code_information": [ { "code": "372", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 4745.4568, "maximum": 27772.2, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 6979.76 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 9788.33 } ] } ] }, { "description": "INFECTIOUS AND PARASITIC DISEASES WITH O.R. PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "855", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 6903.91, "maximum": 24769.8, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 20918.8 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 14353.66 } ] } ] }, { "description": "GTT 3HR", "code_information": [ { "code": "82951", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 232.5, "discounted_cash": 44.0, "minimum": 11.1969, "maximum": 186.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12.61, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.16 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 51.99 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 11.2 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.16 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 57.79 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 57.79 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.31, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 18.02, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 13.64, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.24, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 13.51, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.25 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.42 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.51, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 22.92 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.16 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.98 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.24, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.63 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 21.07 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.31, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "CATH BALLOON NC EUPHORA 3.25X1", "code_information": [ { "code": "C1725", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 462.76, "10th_percentile": 256.45, "90th_percentile": 2515.23, "count": "21" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 270.69, "10th_percentile": 106.59, "90th_percentile": 1342.29, "count": "14" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 484.0, "10th_percentile": 143.56, "90th_percentile": 543.74, "count": "1 through 10" } ] } ] }, { "description": "NEONATE BWT 2000-2499G W MAJOR ANOMALY - SOI : 4", "code_information": [ { "code": "6214", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 168610.59, "maximum": 178727.22, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 175646.87 } ] } ] }, { "description": "CATH CORDIS 6FFR 3DRC", "code_information": [ { "code": "C1887", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 115.24, "10th_percentile": 81.0, "90th_percentile": 503.66, "count": "23" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 156.51, "10th_percentile": 102.6, "90th_percentile": 572.45, "count": "11" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 129.36, "10th_percentile": 24.35, "90th_percentile": 512.12, "count": "1 through 10" } ] } ] }, { "description": "CATHETER EUPHORA 2.25X12MM", "code_information": [ { "code": "C1725", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 462.76, "10th_percentile": 256.45, "90th_percentile": 2515.23, "count": "21" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 270.69, "10th_percentile": 106.59, "90th_percentile": 1342.29, "count": "14" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 484.0, "10th_percentile": 143.56, "90th_percentile": 543.74, "count": "1 through 10" } ] } ] }, { "description": "IGE TOMATO", "code_information": [ { "code": "86003", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 16.3, "discounted_cash": 3.0, "minimum": 2.445, "maximum": 352.08, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5.12, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.36 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 16.3 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 4.54 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.36 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 16.3 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 16.3 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 37.06, "10th_percentile": 37.06, "90th_percentile": 222.36, "count": "1 through 10" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7.83, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 7.31, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 5.53, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.61, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.81 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.31 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 9.3 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.36 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.72 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.61, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "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": "fee schedule", "standard_charge_dollar": 7.15 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 10.36, "10th_percentile": 10.36, "90th_percentile": 10.36, "count": "1 through 10" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 8.54 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.83, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "EXTRACORPOREAL MEMBRANE OXYGENATION (ECMO)- SOI : 3", "code_information": [ { "code": "0093", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 205209.59, "maximum": 217522.16, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 213773.18 } ] } ] }, { "description": "MAJOR GASTROINTESTINAL & PERITONEAL INFECTIONS - SOI : 3", "code_information": [ { "code": "2483", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 13102.79, "maximum": 13888.96, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 13649.58 } ] } ] }, { "description": "PHOSPHATIDYLSERINE AB", "code_information": [ { "code": "86148", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 162.33, "discounted_cash": 30.0, "minimum": 13.9809, "maximum": 129.864, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.75, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.68 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 64.92 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 13.98 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.68 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 72.15 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 72.15 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.11, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 22.5, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 17.03, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 26.52, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.04 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.74 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 28.63 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.68 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 29.95 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 26.52, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 16.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.02 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 16.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 26.3 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 24.11, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "CLOSED TX ANKLE FRACTURE W/MAN", "code_information": [ { "code": "27810", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6566.7, "discounted_cash": 1247.0, "minimum": 640.822, "maximum": 5253.36, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 640.82, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 1802.67 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 962.33 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 2005.98 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 2005.98 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 980.85, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 915.46, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 693.13, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1078.94, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 686.6, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 686.6, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 24.6, "median_amount": 610.83, "10th_percentile": 610.83, "90th_percentile": 610.83, "count": "1 through 10" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1078.94, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 653.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 653.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 653.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 980.85, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "VASCULAR STENT SYSTEM 6X120", "code_information": [ { "code": "C1876", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 3100.8, "10th_percentile": 1880.29, "90th_percentile": 7522.24, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 3482.69, "10th_percentile": 3482.69, "90th_percentile": 3482.69, "count": "1 through 10" } ] } ] }, { "description": "PICC REPLACEMENT SAME SITE", "code_information": [ { "code": "36584", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3116.25, "discounted_cash": 592.0, "minimum": 444.6, "maximum": 2493.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 627.35, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 2169.4 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 1158.1 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 2414.07 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 2414.07 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 960.23, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 896.21, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 678.56, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1056.25, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 672.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 672.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1056.25, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 640.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 640.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 640.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 960.23, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "STENT RESOLUTE ONYX 3.50 X22MM", "code_information": [ { "code": "C1874", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 4258.8, "10th_percentile": 4258.8, "90th_percentile": 4420.0, "count": "1 through 10" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1456.46, "10th_percentile": 975.0, "90th_percentile": 4680.0, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1444.95, "10th_percentile": 1444.95, "90th_percentile": 1444.95, "count": "1 through 10" } ] } ] }, { "description": "Interleukin-6, Serum", "code_information": [ { "code": "83520", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 297.0, "discounted_cash": 48.0, "minimum": 5.0445, "maximum": 585.36, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 16.92, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.37 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 69.77 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 15.02 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.37 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 77.54 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 77.54 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 121.41, "10th_percentile": 121.41, "90th_percentile": 121.41, "count": "1 through 10" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 25.91, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 24.18, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 18.31, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 28.5, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 18.13, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.83 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 34.11 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.13, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 30.76 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.37 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 32.18 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 28.5, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.66 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 12.78, "10th_percentile": 12.78, "90th_percentile": 12.78, "count": "1 through 10" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 21.19 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 25.91, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "Insert i-aort percut device", "code_information": [ { "code": "33967", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6258.75, "discounted_cash": 1189.0, "minimum": 193.45, "maximum": 5507.704, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 362.37 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 193.45 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 403.24 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 403.24 } ] } ] }, { "description": "INVANZ", "drug_information": { "unit": 1.0, "type": "GR" }, "code_information": [ { "code": "60505619604", "type": "NDC" }, { "code": "J1335", "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": 19.0, "median_amount": 213.53, "10th_percentile": 213.53, "90th_percentile": 213.53, "count": "1 through 10" } ] } ] }, { "description": "RUSH PINS 803-01-12", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "LIVER FIBROSIS RISK PROFILE", "code_information": [ { "code": "80076", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 39.05, "discounted_cash": 69.0, "minimum": 5.8575, "maximum": 292.6, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.01, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.53 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 33.01 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 7.11 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.53 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 36.68 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 36.68 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 204.82, "10th_percentile": 204.82, "90th_percentile": 248.71, "count": "11" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12.26, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 11.44, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 8.66, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 69.49, "10th_percentile": 65.83, "90th_percentile": 70.96, "count": "1 through 10" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 13.48, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 8.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.22 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.13 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 14.55 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.53 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.22 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.48, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 8.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.19 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 69.49, "10th_percentile": 69.49, "90th_percentile": 69.49, "count": "18" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 8.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 70.96, "10th_percentile": 65.84, "90th_percentile": 78.05, "count": "12" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 13.37 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.26, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "MRI LT LOWER EXT JNT W/WO", "code_information": [ { "code": "73723", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3543.75, "discounted_cash": 673.0, "minimum": 139.0326, "maximum": 4352.096, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 139.03, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 475.54 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 1542.67 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 332.21 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 475.54 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1714.51 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 1714.51 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 1984.5, "10th_percentile": 1984.5, "90th_percentile": 1984.5, "count": "1 through 10" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 212.81, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 198.62, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 150.38, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 234.09, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 148.96, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 504.07 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 665.57 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 148.96, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 600.2 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 475.54 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 627.9 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 234.09, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 141.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 461.69 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 141.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 141.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 591.5 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 212.81, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "SCREW CORTEX SELF TAPPING 18MM", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "OTHER STOMACH, ESOPHAGEAL & DUODENAL PROCEDURES - SOI : 3", "code_information": [ { "code": "2223", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 40002.67, "maximum": 42402.83, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 41672.02 } ] } ] }, { "description": "MALIGNANCY OF HEPATOBILIARY SYSTEM & PANCREAS - SOI : 1", "code_information": [ { "code": "2811", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 9773.61, "maximum": 10360.03, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 10181.48 } ] } ] }, { "description": "OTHER KIDNEY AND URINARY TRACT DIAGNOSES WITH CC", "code_information": [ { "code": "699", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 4734.3736, "maximum": 24019.2, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 7417.6 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 9730.81 } ] } ] }, { "description": "CORT SCREW 2319-48", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "ACROMIOBLASTER EP BURR4M", "code_information": [ { "code": "A4649", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 10.66, "10th_percentile": 3.56, "90th_percentile": 309.79, "count": "12" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 9.49, "10th_percentile": 3.56, "90th_percentile": 336.36, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 9.49, "10th_percentile": 8.78, "90th_percentile": 73.99, "count": "1 through 10" } ] } ] }, { "description": "STENT COR XIENCE SIERA 2.75X12", "code_information": [ { "code": "C1874", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 4258.8, "10th_percentile": 4258.8, "90th_percentile": 4420.0, "count": "1 through 10" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1456.46, "10th_percentile": 975.0, "90th_percentile": 4680.0, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1444.95, "10th_percentile": 1444.95, "90th_percentile": 1444.95, "count": "1 through 10" } ] } ] }, { "description": "DENTAL AND ORAL DISEASES WITH CC", "code_information": [ { "code": "158", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 4105.8638, "maximum": 21016.8, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 7018.24 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 8722.25 } ] } ] }, { "description": "XR FEMUR 2 VIEWS-LT", "code_information": [ { "code": "73552", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 535.26, "discounted_cash": 101.0, "minimum": 34.6822, "maximum": 428.208, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 34.68, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 112.36 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 322.43 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 69.43 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 112.36 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 358.35 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 358.35 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 363.98, "10th_percentile": 330.89, "90th_percentile": 363.98, "count": "1 through 10" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 53.09, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 49.55, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 37.51, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 1348.22, "10th_percentile": 1348.22, "90th_percentile": 1348.22, "count": "1 through 10" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 114.22, "10th_percentile": 96.35, "90th_percentile": 114.22, "count": "1 through 10" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 58.39, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 37.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 119.1 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 157.26 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 37.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "QTC Medical Group", "plan_name": "QTC Medical Group", "methodology": "fee schedule", "standard_charge_dollar": 51.82 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 141.82 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 112.36 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 148.36 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 58.39, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 35.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 109.09 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 101.7, "10th_percentile": 101.7, "90th_percentile": 101.7, "count": "11" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 35.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 35.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 101.7, "10th_percentile": 96.35, "90th_percentile": 114.22, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 72.96 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 53.09, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "KNEE REVISION", "code_information": [ { "code": "C1776", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 4588.1, "10th_percentile": 1617.12, "90th_percentile": 11630.3, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 9120.0, "10th_percentile": 9120.0, "90th_percentile": 9120.0, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 8640.0, "10th_percentile": 8640.0, "90th_percentile": 9120.0, "count": "1 through 10" } ] } ] }, { "description": "FIXATION NAIL 12M 130DEG", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "VAGINAL DELIVERY LEVEL 2", "code_information": [ { "code": "59610", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3669.0, "discounted_cash": 697.0, "minimum": 550.35, "maximum": 3382.16, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 3039.37 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 1622.52 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 3382.16 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 3382.16 } ] } ] }, { "description": "SCHIZOPHRENIA - SOI : 2", "code_information": [ { "code": "7502", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 6134.05, "maximum": 6502.1, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 6390.03 } ] } ] }, { "description": "GUIDEWIRE CHOICE PT .014X182", "code_information": [ { "code": "C1769", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 228.66, "10th_percentile": 43.17, "90th_percentile": 1333.19, "count": "49" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 200.16, "10th_percentile": 45.57, "90th_percentile": 746.52, "count": "29" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 130.22, "10th_percentile": 39.18, "90th_percentile": 442.41, "count": "15" } ] } ] }, { "description": "ACUTE & SUBACUTE ENDOCARDITIS - SOI : 3", "code_information": [ { "code": "1933", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 43355.73, "maximum": 45957.07, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 45165.0 } ] } ] }, { "description": "POLYSOMNOGRAM W/CPAP", "code_information": [ { "code": "95811", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4582.55, "discounted_cash": 870.0, "minimum": 342.2258, "maximum": 5004.824, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 342.23, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 1426.9 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 458.08 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1584.86 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 1584.86 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 523.82, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 488.89, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 370.16, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 576.2, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 366.67, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 366.67, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 576.2, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 349.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 349.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 349.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 1061.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 523.82, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "EXTENSIVE ABDOMINALTHORACIC PROCEDURES FOR MULT SIGNIFICANT TRAUMA - SOI : 3", "code_information": [ { "code": "9113", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 36875.0, "maximum": 39087.5, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 38413.83 } ] } ] }, { "description": "KIDNEY TRANSPLANT WITH HEMODIALYSIS WITHOUT MCC", "code_information": [ { "code": "651", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 24300.0, "maximum": 115730.0, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 115730.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 35527.5 } ] } ] }, { "description": "STENT ONYX FRONTIER 3.0 X 38MM", "code_information": [ { "code": "C1874", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 4258.8, "10th_percentile": 4258.8, "90th_percentile": 4420.0, "count": "1 through 10" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1456.46, "10th_percentile": 975.0, "90th_percentile": 4680.0, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1444.95, "10th_percentile": 1444.95, "90th_percentile": 1444.95, "count": "1 through 10" } ] } ] }, { "description": "BILATERAL OR MULTIPLE MAJOR JOINT PROCEDURES OF LOWER EXTREMITY WITHOUT MCC", "code_information": [ { "code": "462", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 9900.0, "maximum": 29146.734, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 20321.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 25501.42 } ] } ] }, { "description": "OTHER KIDNEY & URINARY TRACT DIAGNOSES, SIGNS & SYMPTOMS - SOI : 1", "code_information": [ { "code": "4681", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 7280.07, "maximum": 7716.88, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 7583.88 } ] } ] }, { "description": "ECG MONIT/ UP TO 48 HRS, RECOR", "code_information": [ { "code": "93225", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 906.55, "discounted_cash": 172.0, "minimum": 53.018, "maximum": 725.24, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 53.02, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 295.47 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 94.86 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 328.18 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 328.18 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 81.15, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 75.74, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 57.35, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 89.27, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 56.81, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 56.81, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 89.27, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 54.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 54.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 54.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 221.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 81.15, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "NEONATE, TRANSFERRED < 5 DAYS OLD, BORN HERE - SOI : 4", "code_information": [ { "code": "5814", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 7150.19, "maximum": 7579.2, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 7448.57 } ] } ] }, { "description": "INTUBATION ENDO EMERG", "code_information": [ { "code": "31500", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1330.41, "discounted_cash": 229.0, "minimum": 94.3936, "maximum": 1064.328, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 94.39, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 270.84 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 144.58 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 301.39 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 301.39 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 144.48, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 134.85, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 102.1, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 158.93, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 101.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 101.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 158.93, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 96.32, "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": 19.0, "median_amount": 252.78, "10th_percentile": 252.78, "90th_percentile": 252.78, "count": "1 through 10" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 96.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 96.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 258.1, "10th_percentile": 258.1, "90th_percentile": 258.1, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 144.48, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "XR ANKLE 3 +V-LT", "code_information": [ { "code": "73610", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 549.29, "discounted_cash": 104.0, "minimum": 34.6822, "maximum": 439.432, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 75.0, "median_amount": 411.97, "10th_percentile": 411.97, "90th_percentile": 411.97, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 34.68, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 112.36 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 322.43 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 69.43 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 112.36 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 358.35 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 358.35 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 339.56, "10th_percentile": 307.6, "90th_percentile": 373.52, "count": "21" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 53.09, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 49.55, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 37.51, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 164.79, "10th_percentile": 149.81, "90th_percentile": 326.78, "count": "14" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 106.56, "10th_percentile": 98.87, "90th_percentile": 117.22, "count": "42" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 58.39, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 37.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 119.1 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 157.26 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 37.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "QTC Medical Group", "plan_name": "QTC Medical Group", "methodology": "fee schedule", "standard_charge_dollar": 51.82 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 141.82 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 112.36 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 148.36 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 58.39, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 35.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 109.09 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 104.37, "10th_percentile": 104.37, "90th_percentile": 104.37, "count": "28" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 35.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 35.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 104.37, "10th_percentile": 104.37, "90th_percentile": 117.22, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 68.82 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 53.09, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "STENT MONORAIL 3.5X16M", "code_information": [ { "code": "C1874", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 4258.8, "10th_percentile": 4258.8, "90th_percentile": 4420.0, "count": "1 through 10" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1456.46, "10th_percentile": 975.0, "90th_percentile": 4680.0, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1444.95, "10th_percentile": 1444.95, "90th_percentile": 1444.95, "count": "1 through 10" } ] } ] }, { "description": "MRI LT LOWER EXT JNT W/CONTRAS", "code_information": [ { "code": "73722", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4331.25, "discounted_cash": 822.0, "minimum": 312.4142, "maximum": 3465.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 312.41, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 990.07 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 2750.51 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 592.31 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 990.07 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 3056.88 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 3056.88 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 2425.5, "10th_percentile": 2425.5, "90th_percentile": 2425.5, "count": "1 through 10" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 478.19, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 446.31, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 337.92, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 526.0, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 334.73, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1049.47 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1385.71 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 334.73, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 1249.6 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 990.07 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1307.27 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 526.0, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 318.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 961.23 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 318.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 318.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 511.79 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 478.19, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "ADRENAL AND PITUITARY PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "615", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 6750.0, "maximum": 14591.907, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 14098.9 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 13415.09 } ] } ] }, { "description": "MYCOPLASMA AB IGG QL", "code_information": [ { "code": "86738", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 212.0, "discounted_cash": 40.0, "minimum": 11.5188, "maximum": 169.6, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12.98, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.68 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 53.49 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 11.52 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.68 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 59.45 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 59.45 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.86, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 18.54, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 14.03, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.85, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 13.9, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.81 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26.15 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.9, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 23.58 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.68 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.67 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.85, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 13.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.14 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 13.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 21.68 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.86, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "SHOULDER & ELBOW JOINT REPLACEMENT - SOI : 1", "code_information": [ { "code": "3221", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 20692.29, "maximum": 21933.83, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 21555.8 } ] } ] }, { "description": "IGE PEANUT W/COMPONENT RFLX", "code_information": [ { "code": "86003", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 16.3, "discounted_cash": 3.0, "minimum": 2.445, "maximum": 352.08, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5.12, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.36 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 16.3 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 4.54 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.36 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 16.3 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 16.3 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 37.06, "10th_percentile": 37.06, "90th_percentile": 222.36, "count": "1 through 10" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7.83, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 7.31, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 5.53, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.61, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.81 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.31 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 9.3 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.36 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.72 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.61, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "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": "fee schedule", "standard_charge_dollar": 7.15 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 10.36, "10th_percentile": 10.36, "90th_percentile": 10.36, "count": "1 through 10" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 8.54 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.83, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "Hepatitis Be Antigen", "code_information": [ { "code": "86317", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 14.99, "discounted_cash": 2.0, "minimum": 2.2485, "maximum": 251.8, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14.69, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.99 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 14.99 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 13.04 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.99 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 14.99 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 14.99 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14.99, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 14.99, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 14.99, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.99, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 14.99, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.99 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.99 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.99, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 14.99 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.99 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.99 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.99, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 14.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.99 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 14.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 14.99 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.99, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "MESH 3DMAX 6.2X4.1LT", "code_information": [ { "code": "C1781", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1862.28, "10th_percentile": 1862.28, "90th_percentile": 11852.02, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1206.78, "10th_percentile": 1206.78, "90th_percentile": 1206.78, "count": "1 through 10" } ] } ] }, { "description": "CULT GC SCR", "code_information": [ { "code": "87081", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 244.0, "discounted_cash": 46.0, "minimum": 5.7681, "maximum": 195.2, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5.77 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.35 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 29.77 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 29.77 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.95, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 9.28, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 7.03, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.94, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 6.96, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.91 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.09 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.96, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 11.8 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.35 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.35 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10.94, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 6.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.08 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 6.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 10.86 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9.95, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 75.0, "median_amount": 6.63, "10th_percentile": 6.63, "90th_percentile": 6.63, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.5, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.35 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 26.79 } ] } ] }, { "description": "MALIGNANT BREAST DISORDERS WITH CC", "code_information": [ { "code": "598", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 5131.5216, "maximum": 24769.8, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 7921.29 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 10845.77 } ] } ] }, { "description": "CT SINUS W/O", "code_information": [ { "code": "70486", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2817.38, "discounted_cash": 535.0, "minimum": 41.6598, "maximum": 2253.904, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 41.66, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 135.95 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 452.8 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 97.51 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 135.95 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 503.24 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 503.24 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 1741.65, "10th_percentile": 1577.73, "90th_percentile": 1915.82, "count": "1 through 10" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 63.77, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 59.51, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 45.06, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 535.3, "10th_percentile": 507.13, "90th_percentile": 601.23, "count": "1 through 10" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 70.14, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 44.64, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 144.11 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 190.28 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 44.64, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 171.59 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 135.95 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 179.51 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 70.14, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 42.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 131.99 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 535.3, "10th_percentile": 535.3, "90th_percentile": 535.3, "count": "1 through 10" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 42.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 42.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 507.13, "10th_percentile": 507.13, "90th_percentile": 535.3, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 151.76 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 63.77, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "IV THROMBOLYTIC THERAPY", "code_information": [ { "code": "92977", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1172.6, "discounted_cash": 222.0, "minimum": 47.163, "maximum": 938.08, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 129.38, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 411.77 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 219.82 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 458.21 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 458.21 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 198.03, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 184.83, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 139.94, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 217.83, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 138.62, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 138.62, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 217.83, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 132.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 132.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 132.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 198.03, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "CT ORBIT/SELLA/IAC WO", "code_information": [ { "code": "70480", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2363.0, "discounted_cash": 448.0, "minimum": 41.6598, "maximum": 1890.4, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 41.66, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 135.95 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 452.8 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 97.51 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 135.95 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 503.24 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 503.24 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 63.77, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 59.51, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 45.06, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 70.14, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 44.64, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 144.11 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 190.28 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 44.64, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 171.59 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 135.95 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 179.51 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 70.14, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 42.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 131.99 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 42.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 42.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 151.76 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 63.77, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "STENT INTEGRITY RX 3.5X18", "code_information": [ { "code": "C1876", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 3100.8, "10th_percentile": 1880.29, "90th_percentile": 7522.24, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 3482.69, "10th_percentile": 3482.69, "90th_percentile": 3482.69, "count": "1 through 10" } ] } ] }, { "description": "PULLALARIA PULLALANS", "code_information": [ { "code": "86003", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 52.51, "discounted_cash": 3.0, "minimum": 2.445, "maximum": 352.08, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5.12, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.36 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 21.09 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 4.54 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.36 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 23.44 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 23.44 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 37.06, "10th_percentile": 37.06, "90th_percentile": 222.36, "count": "1 through 10" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7.83, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 7.31, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 5.53, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.61, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.81 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.31 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 9.3 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.36 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.72 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.61, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "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": "fee schedule", "standard_charge_dollar": 7.15 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 10.36, "10th_percentile": 10.36, "90th_percentile": 10.36, "count": "1 through 10" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 8.54 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.83, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "TRAUMA TO THE SKIN, SUBCUTANEOUS TISSUE AND BREAST WITH MCC", "code_information": [ { "code": "604", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 6886.8234, "maximum": 28522.8, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 14102.3 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 14113.02 } ] } ] }, { "description": "SPINAL DISORDERS & INJURIES - SOI : 4", "code_information": [ { "code": "0404", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 56043.09, "maximum": 59405.67, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 58381.82 } ] } ] }, { "description": "SKIN GRAFTS FOR INJURIES WITHOUT CCMCC", "code_information": [ { "code": "905", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 7582.2942, "maximum": 21767.4, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 10409.8 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 14221.36 } ] } ] }, { "description": "HYDRATE IV INFUSION ADD-ON(ER)", "code_information": [ { "code": "96361", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 253.96, "discounted_cash": 48.0, "minimum": 11.9103, "maximum": 203.168, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 75.0, "median_amount": 190.47, "10th_percentile": 190.47, "90th_percentile": 190.47, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.66, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 37.1 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 11.91 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 41.21 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 41.21 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 28.56, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 26.66, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 20.18, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 108.39, "10th_percentile": 48.25, "90th_percentile": 253.96, "count": "69" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 31.42, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 19.99, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.99, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 31.42, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 19.04, "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": 19.0, "median_amount": 48.25, "10th_percentile": 48.25, "90th_percentile": 144.76, "count": "36" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 19.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 19.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 54.2, "10th_percentile": 48.25, "90th_percentile": 137.14, "count": "11" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 28.56, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "KIDNEY AND URINARY TRACT SIGNS AND SYMPTOMS WITH MCC", "code_information": [ { "code": "695", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 5247.4334, "maximum": 27021.6, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 10705.7 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 10965.61 } ] } ] }, { "description": "MENSTRUAL & OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS - SOI : 3", "code_information": [ { "code": "5323", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 16870.32, "maximum": 17882.54, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 17574.34 } ] } ] }, { "description": "02A DAT SINGLE OBI", "code_information": [ { "code": "86880", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 15.85, "discounted_cash": 3.0, "minimum": 2.3775, "maximum": 150.1, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.85, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.6 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 15.85 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 15.85 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.6 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 15.85 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 15.85 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.85, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 15.85, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 15.85, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15.85, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 15.85, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.06 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.64 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.85, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 9.59 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.6 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.04 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.85, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 15.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.38 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 15.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 15.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 15.85 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15.85, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "US SCROTUM AND CNTS", "code_information": [ { "code": "76870", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1096.79, "discounted_cash": 208.0, "minimum": 41.6598, "maximum": 877.432, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 41.66, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 135.95 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 452.8 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 97.51 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 135.95 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 503.24 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 503.24 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 614.2, "10th_percentile": 614.2, "90th_percentile": 678.01, "count": "1 through 10" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 63.77, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 59.51, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 45.06, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 234.05, "10th_percentile": 234.05, "90th_percentile": 234.06, "count": "1 through 10" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 70.14, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 44.64, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 144.11 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 190.28 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 44.64, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 171.59 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 135.95 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 179.51 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 70.14, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 42.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 131.99 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 208.39, "10th_percentile": 208.39, "90th_percentile": 208.39, "count": "1 through 10" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 42.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 42.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 197.42, "10th_percentile": 197.42, "90th_percentile": 197.42, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 161.48 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 63.77, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "POSTPARTUM AND POST ABORTION DIAGNOSIS WITH O.R. PROCEDURE- SOI : 3", "code_information": [ { "code": "5483", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 17923.7, "maximum": 18999.12, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 18671.68 } ] } ] }, { "description": "KIDNEY & URINARY TRACT PROCEDURES FOR MALIGNANCY - SOI : 3", "code_information": [ { "code": "4423", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 33630.82, "maximum": 35648.67, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 35034.26 } ] } ] }, { "description": "ANOXIC & OTHER SEVERE BRAIN DAMAGE - SOI : 4", "code_information": [ { "code": "0594", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 52862.89, "maximum": 56034.66, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 55068.91 } ] } ] }, { "description": "MUSCULOSKELETAL MALIGNANCY & PATHOL FRACTURE DT MUSCSKEL MALIG - SOI : 4", "code_information": [ { "code": "3434", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 49485.96, "maximum": 52455.12, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 51551.06 } ] } ] }, { "description": "CATH NC EUPHORA RX 4.0MMX15MM", "code_information": [ { "code": "C1725", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 462.76, "10th_percentile": 256.45, "90th_percentile": 2515.23, "count": "21" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 270.69, "10th_percentile": 106.59, "90th_percentile": 1342.29, "count": "14" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 484.0, "10th_percentile": 143.56, "90th_percentile": 543.74, "count": "1 through 10" } ] } ] }, { "description": "XR BARIUM ENEMA W/AIR", "code_information": [ { "code": "74280", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1572.5, "discounted_cash": 298.0, "minimum": 69.8936, "maximum": 1258.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 69.89, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 227.2 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 736.17 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 158.53 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 227.2 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 818.17 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 818.17 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 106.98, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 99.85, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 75.6, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 117.68, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 74.89, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 240.83 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 317.99 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 74.89, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 286.75 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 227.2 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 299.99 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 117.68, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 71.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 220.58 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 298.78, "10th_percentile": 298.78, "90th_percentile": 298.78, "count": "1 through 10" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 71.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 71.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 181.48 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 106.98, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "CORONARY BYPASS WO AMI OR COMPLEX PDX - SOI : 1", "code_information": [ { "code": "1661", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 36186.44, "maximum": 38357.62, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 37696.53 } ] } ] }, { "description": "DISORDERS OF PERSONALITY AND IMPULSE CONTROL", "code_information": [ { "code": "883", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 10483.3, "maximum": 43534.8, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 10483.3 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 18850.92 } ] } ] }, { "description": "ACUTE LEUKEMIA - SOI : 3", "code_information": [ { "code": "6903", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 59837.36, "maximum": 63427.6, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 62334.43 } ] } ] }, { "description": "ALCOHOL ABUSE & DEPENDENCE - SOI : 4", "code_information": [ { "code": "7754", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 21101.03, "maximum": 22367.1, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 21981.6 } ] } ] }, { "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", "minimum": 17126.7766, "maximum": 56295.0, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 34027.4 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 38195.57 } ] } ] }, { "description": "SPECIMEN HANDLING PATH-LAB", "code_information": [ { "code": "99001", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 59.0, "discounted_cash": 11.0, "minimum": 5.3331, "maximum": 47.2, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 24.77 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5.33 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 27.52 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 27.52 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 9.46 } ] } ] }, { "description": "OTHER EAR, NOSE, MOUTH,THROAT & CRANIALFACIAL DIAGNOSES - SOI : 2", "code_information": [ { "code": "1152", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 10051.52, "maximum": 10654.61, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 10470.98 } ] } ] }, { "description": "SMITH&NEPHEW JOURNEY KNE", "code_information": [ { "code": "C1776", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 4588.1, "10th_percentile": 1617.12, "90th_percentile": 11630.3, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 9120.0, "10th_percentile": 9120.0, "90th_percentile": 9120.0, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 8640.0, "10th_percentile": 8640.0, "90th_percentile": 9120.0, "count": "1 through 10" } ] } ] }, { "description": "SKIN ULCERS - SOI : 1", "code_information": [ { "code": "3801", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 6592.46, "maximum": 6988.01, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 6867.57 } ] } ] }, { "description": "GUIDEWIRE VASC .018X150 TAPER - C1769 - 901184", "code_information": [ { "code": "C1769", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 228.66, "10th_percentile": 43.17, "90th_percentile": 1333.19, "count": "49" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 200.16, "10th_percentile": 45.57, "90th_percentile": 746.52, "count": "29" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 130.22, "10th_percentile": 39.18, "90th_percentile": 442.41, "count": "15" } ] } ] }, { "description": "MESH VENTRALIGHT WITH ECHO 6ö", "code_information": [ { "code": "C1781", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1862.28, "10th_percentile": 1862.28, "90th_percentile": 11852.02, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1206.78, "10th_percentile": 1206.78, "90th_percentile": 1206.78, "count": "1 through 10" } ] } ] }, { "description": "CT LT UPPER EXT WO CONTRAST", "code_information": [ { "code": "73200", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2772.42, "discounted_cash": 526.0, "minimum": 41.6598, "maximum": 2217.936, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 75.0, "median_amount": 2079.32, "10th_percentile": 2079.32, "90th_percentile": 2079.32, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 41.66, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 135.95 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 452.8 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 97.51 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 135.95 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 503.24 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 503.24 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 63.77, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 59.51, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 45.06, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 831.73, "10th_percentile": 756.11, "90th_percentile": 831.73, "count": "1 through 10" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 537.85, "10th_percentile": 499.04, "90th_percentile": 591.63, "count": "1 through 10" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 70.14, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 44.64, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 144.11 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 190.28 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 44.64, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 171.59 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 135.95 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 179.51 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 70.14, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 42.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 131.99 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 526.76, "10th_percentile": 526.76, "90th_percentile": 526.76, "count": "1 through 10" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 42.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 42.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 151.76 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 63.77, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "AER OR VAP INH DEM/EVAL", "code_information": [ { "code": "94664", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 199.45, "discounted_cash": 37.0, "minimum": 29.9175, "maximum": 199.45, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 87.26, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 199.45 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 160.05 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 199.45 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 199.45 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 133.56, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 124.66, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 94.38, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 146.92, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 93.49, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 93.49, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 146.92, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 89.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 89.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 89.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 168.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 133.56, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "RT HEART CATH", "code_information": [ { "code": "93451", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 11676.8, "discounted_cash": 2218.0, "minimum": 1292.0026, "maximum": 9341.44, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1292.0, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 4702.42 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 2023.46 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 5215.41 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 5215.41 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1977.56, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 1845.72, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 1397.47, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2175.31, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1384.29, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1384.29, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2175.31, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1318.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1318.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 1318.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1977.56, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "SCRW CONICAL CANNULATED 5X60", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "GONADOTROPIN-RELEASING HORMONE", "code_information": [ { "code": "83727", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 981.45, "discounted_cash": 186.0, "minimum": 14.9553, "maximum": 785.16, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 16.85, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.26 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 69.45 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 14.96 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.26 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 77.18 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 77.18 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 25.79, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 24.07, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 18.22, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 28.36, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 18.05, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.71 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 33.95 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.05, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 30.62 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.26 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 32.03 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 28.36, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 17.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.55 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 17.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 17.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 28.15 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 25.79, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "INJ PARAVERT F JNT L/S 1 LEV - 64493 - 004013", "code_information": [ { "code": "64493", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2323.52, "discounted_cash": 500.0, "minimum": 348.528, "maximum": 2636.544, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 352.49, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 1080.03 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 576.56 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 1201.83 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 1201.83 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 539.52, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 503.55, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 381.26, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 593.47, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 377.66, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 377.66, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 593.47, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 359.68, "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": 19.0, "median_amount": 500.94, "10th_percentile": 500.94, "90th_percentile": 500.94, "count": "1 through 10" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 359.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 359.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 539.52, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "Rpr aa hrn rcr > 10 ncr/strn", "code_information": [ { "code": "49618", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 11488.8, "discounted_cash": 2182.0, "minimum": 945.73, "maximum": 9191.04, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 1771.57 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 945.73 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 1971.37 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 1971.37 } ] } ] }, { "description": "PSEUDOCHOLINESTERASE", "code_information": [ { "code": "82480", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 122.5, "discounted_cash": 23.0, "minimum": 6.8469, "maximum": 98.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7.71, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.11 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 31.79 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 6.85 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.11 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 35.34 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 35.34 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11.81, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 11.02, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 8.34, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.99, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 8.26, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.78 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.55 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.26, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 14.03 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.11 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.67 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.99, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 7.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.79 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 7.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 12.9 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11.81, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "CATH VIABAHN VBX 8X29X135CM", "code_information": [ { "code": "C1874", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1444.95, "10th_percentile": 1444.95, "90th_percentile": 1444.95, "count": "1 through 10" } ] } ] }, { "description": "DISORDERS OF PERSONALITY & IMPULSE CONTROL - SOI : 3", "code_information": [ { "code": "7523", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 12936.62, "maximum": 13712.82, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 13476.48 } ] } ] }, { "description": "SKIN GRAFT EXCEPT FOR SKIN ULCER OR CELLULITIS WITH MCC", "code_information": [ { "code": "576", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 23325.0562, "maximum": 70556.4, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 51213.4 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 46987.8 } ] } ] }, { "description": "ESTRADIOL FREE", "code_information": [ { "code": "82670", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 519.0, "discounted_cash": 82.0, "minimum": 24.3078, "maximum": 415.2, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 27.38, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 39.43 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 112.88 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 24.31 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 39.43 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 125.45 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 125.45 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 268.6, "10th_percentile": 243.32, "90th_percentile": 295.46, "count": "14" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 41.91, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 39.12, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 29.62, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 92.72, "10th_percentile": 27.94, "90th_percentile": 92.72, "count": "1 through 10" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 46.1, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 29.34, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 41.79 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 55.18 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.34, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 49.76 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 39.43 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 52.06 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 46.1, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "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": "fee schedule", "standard_charge_dollar": 38.28 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 82.56, "10th_percentile": 27.94, "90th_percentile": 82.56, "count": "1 through 10" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 27.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 27.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 78.21, "10th_percentile": 78.21, "90th_percentile": 84.29, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 45.74 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 41.91, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "CATH QUANTUM 12MM X 3.75", "code_information": [ { "code": "C1725", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 462.76, "10th_percentile": 256.45, "90th_percentile": 2515.23, "count": "21" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 270.69, "10th_percentile": 106.59, "90th_percentile": 1342.29, "count": "14" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 484.0, "10th_percentile": 143.56, "90th_percentile": 543.74, "count": "1 through 10" } ] } ] }, { "description": "CATH ARMADA BALLOON 6.0X60", "code_information": [ { "code": "C1725", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 462.76, "10th_percentile": 256.45, "90th_percentile": 2515.23, "count": "21" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 270.69, "10th_percentile": 106.59, "90th_percentile": 1342.29, "count": "14" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 484.0, "10th_percentile": 143.56, "90th_percentile": 543.74, "count": "1 through 10" } ] } ] }, { "description": "HYPERTENSION - SOI : 1", "code_information": [ { "code": "1991", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 7043.23, "maximum": 7465.82, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 7337.15 } ] } ] }, { "description": "STENT ONYX FRONTIER 2.5X30MM", "code_information": [ { "code": "C1874", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 4258.8, "10th_percentile": 4258.8, "90th_percentile": 4420.0, "count": "1 through 10" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1456.46, "10th_percentile": 975.0, "90th_percentile": 4680.0, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1444.95, "10th_percentile": 1444.95, "90th_percentile": 1444.95, "count": "1 through 10" } ] } ] }, { "description": "PSA SCREEN - 84153 - 810187", "code_information": [ { "code": "84153", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 233.75, "discounted_cash": 19.0, "minimum": 15.1725, "maximum": 187.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 75.0, "median_amount": 84.3, "10th_percentile": 84.3, "90th_percentile": 84.3, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.02, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.95 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 74.3 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 16.0 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.95 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 82.57 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 82.57 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 130.9, "10th_percentile": 22.92, "90th_percentile": 158.95, "count": "1 through 10" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 27.59, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 25.75, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 19.49, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 18.21, "10th_percentile": 8.78, "90th_percentile": 45.35, "count": "1 through 10" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 30.34, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 19.31, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.5 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 36.31 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.31, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 32.75 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.95 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 34.26 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 30.34, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 18.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.19 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 23.49, "10th_percentile": 19.22, "90th_percentile": 44.41, "count": "18" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 18.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 23.49, "10th_percentile": 18.21, "90th_percentile": 42.08, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 30.11 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 27.59, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "VIRAL ILLNESS - SOI : 2", "code_information": [ { "code": "7232", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 6001.31, "maximum": 6361.39, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 6251.75 } ] } ] }, { "description": "STENT RESOLUTE ONYX 4.0X22MM", "code_information": [ { "code": "C1874", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 4258.8, "10th_percentile": 4258.8, "90th_percentile": 4420.0, "count": "1 through 10" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1456.46, "10th_percentile": 975.0, "90th_percentile": 4680.0, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1444.95, "10th_percentile": 1444.95, "90th_percentile": 1444.95, "count": "1 through 10" } ] } ] }, { "description": "UNLISTED LAP PROCEDURE ESOPH", "code_information": [ { "code": "43289", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 11171.0, "discounted_cash": 2122.0, "minimum": 1675.65, "maximum": 8936.8, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2409.3, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 6428.83 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 3431.93 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 7153.89 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 7153.89 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3687.71, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 3441.86, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 2605.98, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4056.48, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2581.39, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2581.39, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4056.48, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2458.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2458.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 2458.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3687.71, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "BYPASS LHC WITH V GRAM", "code_information": [ { "code": "93459", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 22799.4, "discounted_cash": 4331.0, "minimum": 1292.0026, "maximum": 18239.52, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1292.0, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 4702.42 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 2023.46 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 5215.41 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 5215.41 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1977.56, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 1845.72, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 1397.47, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 13956.59, "10th_percentile": 13956.59, "90th_percentile": 16155.68, "count": "1 through 10" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2175.31, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1384.29, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1384.29, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2175.31, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1318.37, "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": 19.0, "median_amount": 4331.89, "10th_percentile": 4331.89, "90th_percentile": 4331.89, "count": "1 through 10" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1318.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 1318.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 4103.9, "10th_percentile": 4103.9, "90th_percentile": 4331.89, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1977.56, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "SCREW LT 60 6.5 COMPRESSION", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "GUIDING CATH H-STICK 6FR", "code_information": [ { "code": "C1887", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 115.24, "10th_percentile": 81.0, "90th_percentile": 503.66, "count": "23" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 156.51, "10th_percentile": 102.6, "90th_percentile": 572.45, "count": "11" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 129.36, "10th_percentile": 24.35, "90th_percentile": 512.12, "count": "1 through 10" } ] } ] }, { "description": "DIGESTIVE MALIGNANCY WITH MCC", "code_information": [ { "code": "374", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 9549.5622, "maximum": 42033.6, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 18580.8 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 20503.72 } ] } ] }, { "description": "Arthrocentesis asp/inj w/o us", "code_information": [ { "code": "20605", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1398.5, "discounted_cash": 265.0, "minimum": 18.45, "maximum": 1118.8, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 122.33, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 24.94 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 18.45 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 27.8 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 27.8 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 187.25, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 174.76, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 132.32, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 205.97, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 131.07, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.07, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 205.97, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 124.83, "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": 19.0, "median_amount": 265.72, "10th_percentile": 265.72, "90th_percentile": 265.72, "count": "1 through 10" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 124.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 124.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 187.25, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "CMPNT FEM 74X56.3X11.5MM RMD", "code_information": [ { "code": "C1776", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 4588.1, "10th_percentile": 1617.12, "90th_percentile": 11630.3, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 9120.0, "10th_percentile": 9120.0, "90th_percentile": 9120.0, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 8640.0, "10th_percentile": 8640.0, "90th_percentile": 9120.0, "count": "1 through 10" } ] } ] }, { "description": "NON-MALIGNANT BREAST DISORDERS WITH CCMCC", "code_information": [ { "code": "600", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 3878.12, "maximum": 24769.8, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 3878.12 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 9985.82 } ] } ] }, { "description": "MESH ULTIPRO 4.7 X 2.4 X 4", "code_information": [ { "code": "C1781", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1862.28, "10th_percentile": 1862.28, "90th_percentile": 11852.02, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1206.78, "10th_percentile": 1206.78, "90th_percentile": 1206.78, "count": "1 through 10" } ] } ] }, { "description": "SCRW LOCKING CANNULATED 5X40", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "N BLOCK OP/INJ/ANES/PUDENDAL N", "code_information": [ { "code": "64430", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1911.64, "discounted_cash": 363.0, "minimum": 286.746, "maximum": 1529.312, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 352.49, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 1080.03 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 576.56 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 1201.83 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 1201.83 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 539.52, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 503.55, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 381.26, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 593.47, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 377.66, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 377.66, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 593.47, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 359.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 359.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 359.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 539.52, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "NEONATE BIRTHWT >2499G W MAJOR ANOMALY - SOI : 1", "code_information": [ { "code": "6331", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 3347.32, "maximum": 3548.16, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 3487.01 } ] } ] }, { "description": "ABORTION WO D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY - SOI : 3", "code_information": [ { "code": "5643", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 9182.46, "maximum": 9733.41, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 9565.65 } ] } ] }, { "description": "XR RIBS BI W/CXR 4+V", "code_information": [ { "code": "71111", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 826.49, "discounted_cash": 157.0, "minimum": 41.6598, "maximum": 661.192, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 41.66, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 135.95 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 452.8 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 97.51 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 135.95 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 503.24 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 503.24 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 63.77, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 59.51, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 45.06, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 70.14, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 44.64, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 144.11 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 190.28 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 44.64, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "QTC Medical Group", "plan_name": "QTC Medical Group", "methodology": "fee schedule", "standard_charge_dollar": 56.94 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 171.59 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 135.95 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 179.51 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 70.14, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 42.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 131.99 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 42.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 42.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 109.07 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 63.77, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "DRUG TEST DEF 15-21 CLASSES", "code_information": [ { "code": "G0482", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1037.69, "minimum": 155.6535, "maximum": 892.34, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 194.77, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 280.45 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 802.91 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 172.9 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 280.45 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 892.34 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 892.34 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 298.11, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 278.24, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 210.66, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 327.92, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 208.68, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 297.28 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 392.52 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 208.68, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 353.96 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 280.45 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 370.3 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 327.92, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 198.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 272.28 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 198.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 198.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 199.24 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 298.11, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "ELECTIVE KNEE JOINT REPLACEMENT- SOI : 4", "code_information": [ { "code": "3264", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 41614.74, "maximum": 44111.62, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 43351.36 } ] } ] }, { "description": "CARDIAC ARRHYTHMIA & CONDUCTION DISORDERS - SOI : 1", "code_information": [ { "code": "2011", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 5790.25, "maximum": 6137.66, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 6031.88 } ] } ] }, { "description": "PHOSPHORUS BLD", "code_information": [ { "code": "84100", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 137.5, "discounted_cash": 26.0, "minimum": 4.1238, "maximum": 110.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4.65, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.68 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 19.15 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 4.12 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.68 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 21.28 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 21.28 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 85.0, "10th_percentile": 77.0, "90th_percentile": 93.5, "count": "1 through 10" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7.11, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 6.64, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 26.13, "10th_percentile": 20.63, "90th_percentile": 29.34, "count": "29" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 4.98, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.09 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.36 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.98, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 8.44 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.68 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.83 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "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": "fee schedule", "standard_charge_dollar": 6.49 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 26.13, "10th_percentile": 4.74, "90th_percentile": 26.13, "count": "46" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 4.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 26.68, "10th_percentile": 24.75, "90th_percentile": 29.34, "count": "11" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 7.75 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.11, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "CATH TREK DIALTION 3.5X20MM", "code_information": [ { "code": "C1725", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 256.5, "10th_percentile": 256.5, "90th_percentile": 288.09, "count": "1 through 10" } ] } ] }, { "description": "REHABILITATION WITHOUT CCMCC", "code_information": [ { "code": "946", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 5400.0, "maximum": 27021.6, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 10597.9 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 10994.37 } ] } ] }, { "description": "GUIDEWIRE GLIDEX.035X180", "code_information": [ { "code": "C1769", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 228.66, "10th_percentile": 43.17, "90th_percentile": 1333.19, "count": "49" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 200.16, "10th_percentile": 45.57, "90th_percentile": 746.52, "count": "29" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 130.22, "10th_percentile": 39.18, "90th_percentile": 442.41, "count": "15" } ] } ] }, { "description": "TIBIAL INSERT FIXED SZ 6 LEFT", "code_information": [ { "code": "C1776", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 4588.1, "10th_percentile": 1617.12, "90th_percentile": 11630.3, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 9120.0, "10th_percentile": 9120.0, "90th_percentile": 9120.0, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 8640.0, "10th_percentile": 8640.0, "90th_percentile": 9120.0, "count": "1 through 10" } ] } ] }, { "description": "Administration Fee for Pneumo - G0009 - 004323", "code_information": [ { "code": "G0009", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 111.09, "minimum": 16.6635, "maximum": 111.09, "payers_information": [ { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.99, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 31.42, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 19.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 19.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 19.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 32.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 28.56, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.66, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 111.09 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 41.7 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 111.09 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 111.09 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 28.56, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 26.66, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 20.18, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 31.42, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 19.99, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "COCR HUM STM SHOULDER8.5", "code_information": [ { "code": "C1776", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 4588.1, "10th_percentile": 1617.12, "90th_percentile": 11630.3, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 9120.0, "10th_percentile": 9120.0, "90th_percentile": 9120.0, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 8640.0, "10th_percentile": 8640.0, "90th_percentile": 9120.0, "count": "1 through 10" } ] } ] }, { "description": "SCREW BONE CANNULATED 7.3X65", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "PNEUMOTHORAX WITH MCC", "code_information": [ { "code": "199", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 7150.79, "maximum": 36779.4, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 7150.79 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 16912.43 } ] } ] }, { "description": "Repair of metatarsals", "code_information": [ { "code": "28322", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5302.5, "discounted_cash": 1007.0, "minimum": 795.375, "maximum": 5302.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2891.8, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 5302.5 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 4247.18 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 5302.5 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 5302.5 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4426.23, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 4131.15, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 3127.87, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4868.85, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3098.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3098.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4868.85, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2950.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2950.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 2950.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4426.23, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "THER/PROPH/DIAG IV INF INIT(MS - 96365 - 006002", "code_information": [ { "code": "96365", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 642.25, "discounted_cash": 52.0, "minimum": 41.1, "maximum": 998.59, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 84.76, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 197.29 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 63.34 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 219.13 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 219.13 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 129.74, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 121.09, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 91.68, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 189.73, "10th_percentile": 137.06, "90th_percentile": 998.59, "count": "153" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 142.71, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 90.81, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 90.81, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 142.71, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 86.49, "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": 19.0, "median_amount": 189.73, "10th_percentile": 189.73, "90th_percentile": 189.73, "count": "45" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 86.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 86.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 189.73, "10th_percentile": 137.06, "90th_percentile": 213.1, "count": "33" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 642.25 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 129.74, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "NEUROLOGICAL EYE DISORDERS", "code_information": [ { "code": "123", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 3534.1554, "maximum": 15762.6, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 7631.39 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 7656.18 } ] } ] }, { "description": "EXT FIX SM CAP K-WIRE", "code_information": [ { "code": "C1769", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 228.66, "10th_percentile": 43.17, "90th_percentile": 1333.19, "count": "49" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 200.16, "10th_percentile": 45.57, "90th_percentile": 746.52, "count": "29" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 130.22, "10th_percentile": 39.18, "90th_percentile": 442.41, "count": "15" } ] } ] }, { "description": "MAJOR CARDIOTHORACIC REPAIR OF HEART ANOMALY - SOI : 4", "code_information": [ { "code": "1604", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 206939.12, "maximum": 219355.47, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 215574.89 } ] } ] }, { "description": "ANAL AND PERINEAL PROCEDURES- SOI : 3", "code_information": [ { "code": "2263", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 18010.61, "maximum": 19091.25, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 18762.21 } ] } ] }, { "description": "MONITOR SCREEN 14-DRUG CLASS", "code_information": [ { "code": "80307", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 450.0, "discounted_cash": 7.0, "minimum": 5.8575, "maximum": 960.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 60.9, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 87.68 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 251.05 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 54.06 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 87.68 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 279.01 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 279.01 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 305.11, "10th_percentile": 305.11, "90th_percentile": 336.81, "count": "1 through 10" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 93.21, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 87.0, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 65.87, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 103.52, "10th_percentile": 98.07, "90th_percentile": 116.27, "count": "44" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 102.53, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 65.25, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 92.94 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 122.72 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 65.25, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 110.67 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 87.68 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 115.78 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 102.53, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "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": "fee schedule", "standard_charge_dollar": 85.13 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 103.52, "10th_percentile": 62.14, "90th_percentile": 103.52, "count": "18" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 62.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 62.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 103.52, "10th_percentile": 54.0, "90th_percentile": 116.27, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 95.77 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 93.21, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "G0283 ESTIM UNATT NON-WOUND - G0283 - 034084", "code_information": [ { "code": "G0283", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 119.0, "minimum": 12.0932, "maximum": 127.6, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 39.08 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.55 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 43.4 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 43.4 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.51, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 17.28, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 13.08, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 20.36, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.96, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.96, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.36, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 12.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 79.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.51, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "XR SKULL< 4 V", "code_information": [ { "code": "70250", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 559.63, "discounted_cash": 106.0, "minimum": 41.6598, "maximum": 503.24, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 41.66, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 135.95 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 452.8 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 97.51 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 135.95 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 503.24 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 503.24 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 63.77, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 59.51, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 45.06, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 70.14, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 44.64, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 144.11 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 190.28 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 44.64, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 171.59 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 135.95 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 179.51 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 70.14, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 42.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 131.99 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 42.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 42.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 68.82 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 63.77, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "KNEE & LOWER LEG PROCEDURES EXCEPT FOOT - SOI : 1", "code_information": [ { "code": "3131", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 15900.98, "maximum": 16855.04, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 16564.55 } ] } ] }, { "description": "DM LINER HEAD SZ 0 28MM", "code_information": [ { "code": "C1776", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 4588.1, "10th_percentile": 1617.12, "90th_percentile": 11630.3, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 9120.0, "10th_percentile": 9120.0, "90th_percentile": 9120.0, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 8640.0, "10th_percentile": 8640.0, "90th_percentile": 9120.0, "count": "1 through 10" } ] } ] }, { "description": "Lat retinacular release open", "code_information": [ { "code": "27425", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5891.66, "discounted_cash": 1119.0, "minimum": 883.749, "maximum": 4713.328, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1303.98, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 3640.81 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 1943.59 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 4051.43 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 4051.43 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1995.89, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 1862.83, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 1410.43, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2195.47, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1397.12, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1397.12, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2195.47, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1330.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1330.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 1330.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1995.89, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "3.5MM SCREW X16MM RECESS", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "Treat humerus fracture - 24538 - OR36024538", "code_information": [ { "code": "24538", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7651.25, "discounted_cash": 1453.0, "minimum": 1147.6875, "maximum": 7651.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2891.8, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 7651.25 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 4247.18 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 7651.25 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 7651.25 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4426.23, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 4131.15, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 3127.87, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4868.85, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3098.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3098.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 24.6, "median_amount": 3070.11, "10th_percentile": 3070.11, "90th_percentile": 3070.11, "count": "1 through 10" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4868.85, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2950.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2950.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 2950.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4426.23, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "NM TUMOR LCL WHL BDY", "code_information": [ { "code": "78802", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2856.75, "discounted_cash": 542.0, "minimum": 216.384, "maximum": 2410.87, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 216.38, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1722.53 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 1180.81 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 254.28 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1722.53 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1312.34 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 1312.34 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 331.2, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 309.12, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 234.05, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 364.32, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 231.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1825.88 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2410.87 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 231.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 2174.07 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1722.53 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2274.41 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 364.32, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 220.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1672.36 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 220.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 220.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 788.36 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 331.2, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "QCKFIX SCREW TI CANN 4.0X46MM", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "MASTECTOMY FOR MALIGNANCY WITHOUT CCMCC", "code_information": [ { "code": "583", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 7102.0222, "maximum": 23781.8, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 23781.8 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 16531.82 } ] } ] }, { "description": "Celiac Abs, Frac/Tot IgA, Ref", "code_information": [ { "code": "82784", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 80.25, "discounted_cash": 28.0, "minimum": 3.645, "maximum": 120.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.11, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.12 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 37.57 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 8.09 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.12 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 41.76 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 41.76 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 84.0, "10th_percentile": 44.94, "90th_percentile": 102.0, "count": "1 through 10" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13.95, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 13.02, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 9.86, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 27.0, "10th_percentile": 27.0, "90th_percentile": 64.02, "count": "1 through 10" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15.35, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 9.77, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.91 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.37 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.77, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 16.56 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.12 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.33 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.35, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "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": "fee schedule", "standard_charge_dollar": 12.74 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 28.5, "10th_percentile": 28.5, "90th_percentile": 28.5, "count": "1 through 10" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 9.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 9.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 15.22 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 13.95, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "GUIDING CATH AR 2 6FR", "code_information": [ { "code": "C1887", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 115.24, "10th_percentile": 81.0, "90th_percentile": 503.66, "count": "23" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 156.51, "10th_percentile": 102.6, "90th_percentile": 572.45, "count": "11" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 129.36, "10th_percentile": 24.35, "90th_percentile": 512.12, "count": "1 through 10" } ] } ] }, { "description": "Smear WBC Stool/Leukocyte Assm", "code_information": [ { "code": "89055", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 106.58, "discounted_cash": 20.0, "minimum": 3.7149, "maximum": 85.264, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4.18, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.03 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 17.25 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3.71 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.03 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 19.17 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 19.17 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.41, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 5.98, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 4.53, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.05, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 4.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.39 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.43 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 7.61 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.03 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.96 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.05, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 4.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.85 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 4.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 6.98 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.41, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "EKG-RHYTHM STRIP", "code_information": [ { "code": "93041", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 283.75, "discounted_cash": 53.0, "minimum": 23.5004, "maximum": 269.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 23.5, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 149.08 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 47.86 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 165.58 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 165.58 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 35.97, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 33.57, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 25.42, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 39.57, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 25.18, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.18, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 39.57, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 23.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 23.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 23.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 269.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 35.97, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "CORT SCREW 2319-22", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "EMBOLECTOMY CATHETER 3FR", "code_information": [ { "code": "C1757", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 789.75, "10th_percentile": 416.2, "90th_percentile": 947.7, "count": "1 through 10" } ] } ] }, { "description": "STENT XIENCE SIERRA 2.75 X 33", "code_information": [ { "code": "C1874", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 4258.8, "10th_percentile": 4258.8, "90th_percentile": 4420.0, "count": "1 through 10" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1456.46, "10th_percentile": 975.0, "90th_percentile": 4680.0, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1444.95, "10th_percentile": 1444.95, "90th_percentile": 1444.95, "count": "1 through 10" } ] } ] }, { "description": "STREP B DNA AMP PROBE", "code_information": [ { "code": "87653", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 280.95, "discounted_cash": 53.0, "minimum": 30.5283, "maximum": 224.76, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 34.39, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 49.51 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 141.76 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 30.53 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 49.51 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 157.55 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 157.55 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 52.64, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 49.13, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 37.2, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 57.9, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 36.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 52.48 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 69.3 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 62.49 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 49.51 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 65.38 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 57.9, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 48.07 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 57.44 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 52.64, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "BIO-COMP-ITE CRKSCRW 5.5X14.7M", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "LEAD BLOOD", "code_information": [ { "code": "83655", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 129.03, "discounted_cash": 19.0, "minimum": 10.5357, "maximum": 103.224, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11.87, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.09 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 48.92 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 10.54 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.09 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 54.37 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 54.37 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 72.26, "10th_percentile": 72.26, "90th_percentile": 72.26, "count": "1 through 10" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.17, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 16.95, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 12.84, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.98, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.72, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.11 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.92 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.72, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 21.57 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.09 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.56 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.98, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "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": "fee schedule", "standard_charge_dollar": 16.59 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 19.82 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.17, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "MAJOR LARGE BOWEL PROCEDURES - SOI : 1", "code_information": [ { "code": "2311", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 16521.74, "maximum": 17513.05, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 17211.21 } ] } ] }, { "description": "US PREG AFTER 18 WKS", "code_information": [ { "code": "76811", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1214.25, "discounted_cash": 230.0, "minimum": 73.6803, "maximum": 971.4, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 95.08, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 303.0 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 342.15 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 73.68 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 303.0 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 380.26 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 380.26 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 145.53, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 135.83, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 102.84, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 160.08, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 101.87, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 321.17 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 424.08 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 101.87, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 382.42 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 303.0 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 400.07 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 160.08, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 97.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 294.17 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 97.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 97.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 229.01 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 145.53, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "ELASTIC NAIL GREEN 2.0MM", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "EXTENSIVE OR PROCEDURES FOR OTHER COMPLICATIONS OF TREATMENT - SOI : 2", "code_information": [ { "code": "7922", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 26773.82, "maximum": 28380.25, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 27891.11 } ] } ] }, { "description": "HEMORRHAGE OR HEMATOMA DUE TO COMPLICATION - SOI : 2", "code_information": [ { "code": "8102", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 8745.06, "maximum": 9269.77, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 9110.0 } ] } ] }, { "description": "S-T CRTX LCK SCREW 36M", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "FEMALE REPRODUCTIVE SYSTEM RECONSTRUCTIVE PROCEDURES - SOI : 4", "code_information": [ { "code": "5144", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 56814.74, "maximum": 60223.62, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 59185.67 } ] } ] }, { "description": "CYSTIC FIBROSIS - PULMONARY DISEASE - SOI : 4", "code_information": [ { "code": "1314", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 49953.92, "maximum": 52951.15, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 52038.54 } ] } ] }, { "description": "CATH QUANTUM 8MM X 3.5MM", "code_information": [ { "code": "C1725", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 462.76, "10th_percentile": 256.45, "90th_percentile": 2515.23, "count": "21" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 270.69, "10th_percentile": 106.59, "90th_percentile": 1342.29, "count": "14" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 484.0, "10th_percentile": 143.56, "90th_percentile": 543.74, "count": "1 through 10" } ] } ] }, { "description": "RUSH PIN 3.2 X 140MM", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "STENT XIENCE SIERRA 2.25X15MM", "code_information": [ { "code": "C1874", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 4258.8, "10th_percentile": 4258.8, "90th_percentile": 4420.0, "count": "1 through 10" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1456.46, "10th_percentile": 975.0, "90th_percentile": 4680.0, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1444.95, "10th_percentile": 1444.95, "90th_percentile": 1444.95, "count": "1 through 10" } ] } ] }, { "description": "CATH QUANTUM 12MM X 4.0", "code_information": [ { "code": "C1725", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 462.76, "10th_percentile": 256.45, "90th_percentile": 2515.23, "count": "21" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 270.69, "10th_percentile": 106.59, "90th_percentile": 1342.29, "count": "14" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 484.0, "10th_percentile": 143.56, "90th_percentile": 543.74, "count": "1 through 10" } ] } ] }, { "description": "Rpr fem hernia init blocked", "code_information": [ { "code": "49553", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6186.25, "discounted_cash": 1175.0, "minimum": 927.9375, "maximum": 4949.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1426.89, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 4135.42 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 2207.63 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 4601.82 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 4601.82 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2184.02, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 2038.41, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 1543.37, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2402.42, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1528.81, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1528.81, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2402.42, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1456.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1456.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 1456.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2184.02, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "HLA I TYPING 1 ANTIGEN LR", "code_information": [ { "code": "81374", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 530.71, "discounted_cash": 100.0, "minimum": 64.6671, "maximum": 424.568, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 72.84, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 104.88 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 300.29 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 64.67 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 104.88 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 333.74 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 333.74 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 111.5, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 104.06, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 78.79, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 100.84, "10th_percentile": 100.84, "90th_percentile": 100.84, "count": "1 through 10" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 122.64, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 78.05, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 111.18 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 146.8 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 78.05, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 132.38 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 104.88 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 138.49 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 122.64, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 74.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 101.83 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 74.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 74.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 119.1 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 111.5, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "NS 500ML", "drug_information": { "unit": 500.0, "type": "ML" }, "code_information": [ { "code": "00264780010", "type": "NDC" }, { "code": "J7040", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 75.0, "median_amount": 20.28, "10th_percentile": 20.28, "90th_percentile": 20.28, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 15.14, "10th_percentile": 15.14, "90th_percentile": 18.39, "count": "1 through 10" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 5.14, "10th_percentile": 4.87, "90th_percentile": 5.77, "count": "32" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 5.14, "10th_percentile": 5.14, "90th_percentile": 5.14, "count": "23" } ] } ] }, { "description": "OT CONTRAST BATH 15 MIN", "code_information": [ { "code": "97034", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 92.75, "discounted_cash": 20.0, "minimum": 13.3868, "maximum": 86.4, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13.39, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 42.01 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 13.49 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 46.66 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 46.66 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 20.49, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 19.12, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 14.48, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 22.54, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 14.34, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.34, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 22.54, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 13.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 13.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 79.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 20.49, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "MINOR SMALL AND LARGE BOWEL PROCEDURES WITH CC", "code_information": [ { "code": "345", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 7285.8186, "maximum": 30024.0, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 11753.2 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 14425.56 } ] } ] }, { "description": "CARDIAC STRUCTURAL & VALVULAR DISORDERS - SOI : 4", "code_information": [ { "code": "2004", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 270051.22, "maximum": 286254.29, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 281320.71 } ] } ] }, { "description": "WOUND(S) CARE NON-SELECTIVE(OR", "code_information": [ { "code": "97602", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 264.67, "discounted_cash": 50.0, "minimum": 39.7005, "maximum": 828.744, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 79.96, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 264.67 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 152.02 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 264.67 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 264.67 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 122.39, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 114.23, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 86.49, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 134.62, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 85.67, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.67, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 134.62, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 81.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 81.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 81.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 122.39, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "TIGHTROPE ABS ROUND 20MM", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "CATH GUIDE ADROIT 6FR AL2", "code_information": [ { "code": "C1887", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 115.24, "10th_percentile": 81.0, "90th_percentile": 503.66, "count": "23" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 156.51, "10th_percentile": 102.6, "90th_percentile": 572.45, "count": "11" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 129.36, "10th_percentile": 24.35, "90th_percentile": 512.12, "count": "1 through 10" } ] } ] }, { "description": "STENT GENESIS PRO 7MM X 29 MM", "code_information": [ { "code": "C1876", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 3100.8, "10th_percentile": 1880.29, "90th_percentile": 7522.24, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 3482.69, "10th_percentile": 3482.69, "90th_percentile": 3482.69, "count": "1 through 10" } ] } ] }, { "description": "THYROGLOBULIN AB", "code_information": [ { "code": "84432", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 288.75, "discounted_cash": 54.0, "minimum": 13.9722, "maximum": 231.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.74, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.66 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 64.88 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 13.97 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.66 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 72.11 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 72.11 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.09, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 22.48, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 17.02, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 26.5, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 16.86, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.02 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.72 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.86, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 28.6 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.66 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 29.92 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 26.5, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 16.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.0 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 16.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 26.29 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 24.09, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "ABSCESS DRAINAGE W/CATH", "code_information": [ { "code": "75989", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2070.0, "discounted_cash": 393.0, "minimum": 55.4973, "maximum": 1656.0, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 257.71 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 55.5 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 286.42 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 286.42 } ] } ] }, { "description": "Inject trigeminal nerve", "code_information": [ { "code": "64400", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1398.5, "discounted_cash": 265.0, "minimum": 54.32, "maximum": 1118.8, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 122.33, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 73.45 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 54.32 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 81.87 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 81.87 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 187.25, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 174.76, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 132.32, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 205.97, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 131.07, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.07, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 205.97, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 124.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 124.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 124.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 187.25, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "SCREW CANCELLOUS 20", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "Optx radial shaft fracture", "code_information": [ { "code": "25515", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3535.0, "discounted_cash": 671.0, "minimum": 530.25, "maximum": 3535.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2891.8, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 3535.0 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 3535.0 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 3535.0 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 3535.0 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3535.0, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 3535.0, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 3127.87, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3535.0, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3098.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3098.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 24.6, "median_amount": 3226.48, "10th_percentile": 3226.48, "90th_percentile": 3226.48, "count": "1 through 10" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3535.0, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2950.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2950.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 2950.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3535.0, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "Inc&rmvl fb subq tiss smpl", "code_information": [ { "code": "10120", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2651.25, "discounted_cash": 400.0, "minimum": 75.85, "maximum": 2121.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 162.0, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 102.56 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 75.85 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 114.31 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 114.31 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 247.97, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 231.43, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 175.23, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 272.76, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 173.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 24.6, "median_amount": 86.38, "10th_percentile": 86.38, "90th_percentile": 86.38, "count": "1 through 10" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 272.76, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 165.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 165.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 165.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 247.97, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "CATH EV3 EVERCROSS OTW 6MMX80", "code_information": [ { "code": "C1725", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 462.76, "10th_percentile": 256.45, "90th_percentile": 2515.23, "count": "21" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 270.69, "10th_percentile": 106.59, "90th_percentile": 1342.29, "count": "14" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 484.0, "10th_percentile": 143.56, "90th_percentile": 543.74, "count": "1 through 10" } ] } ] }, { "description": "SKIN GRAFT, EXCEPT HAND, FOR MUSCULOSKELETAL & CONNECTIVE TISSUE DIAGNOSES - SOI : 2", "code_information": [ { "code": "3122", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 23670.98, "maximum": 25091.24, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 24658.79 } ] } ] }, { "description": "GUIDING SHEATH 6FR CURVE", "code_information": [ { "code": "C1887", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 115.24, "10th_percentile": 81.0, "90th_percentile": 503.66, "count": "23" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 156.51, "10th_percentile": 102.6, "90th_percentile": 572.45, "count": "11" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 129.36, "10th_percentile": 24.35, "90th_percentile": 512.12, "count": "1 through 10" } ] } ] }, { "description": "STENT EVERFLEX 6.0 X 80MM", "code_information": [ { "code": "C1876", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 3100.8, "10th_percentile": 1880.29, "90th_percentile": 7522.24, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 3482.69, "10th_percentile": 3482.69, "90th_percentile": 3482.69, "count": "1 through 10" } ] } ] }, { "description": "NM MUGA R/S SINGLE", "code_information": [ { "code": "78472", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2382.5, "discounted_cash": 452.0, "minimum": 159.3186, "maximum": 1906.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 159.32, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 504.43 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 760.0 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 163.66 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 504.43 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 844.66 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 844.66 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 243.86, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 227.6, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 172.32, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 268.24, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 170.7, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 534.7 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 706.01 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 170.7, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 636.66 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 504.43 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 666.05 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 268.24, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 162.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 489.74 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 162.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 162.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 459.72 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 243.86, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "STENT DRUG ELUTING 2.5X8MM", "code_information": [ { "code": "C1876", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 3100.8, "10th_percentile": 1880.29, "90th_percentile": 7522.24, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 3482.69, "10th_percentile": 3482.69, "90th_percentile": 3482.69, "count": "1 through 10" } ] } ] }, { "description": "OPTIFOAM AG POST OP 3.5X10", "code_information": [ { "code": "A6212", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 15.49, "10th_percentile": 7.75, "90th_percentile": 44.12, "count": "13" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 20.69, "10th_percentile": 13.07, "90th_percentile": 38.73, "count": "1 through 10" } ] } ] }, { "description": "GUIDEWIRE COUGAR XT 300CM", "code_information": [ { "code": "C1725", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 462.76, "10th_percentile": 256.45, "90th_percentile": 2515.23, "count": "21" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 270.69, "10th_percentile": 106.59, "90th_percentile": 1342.29, "count": "14" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 484.0, "10th_percentile": 143.56, "90th_percentile": 543.74, "count": "1 through 10" } ] } ] }, { "description": "RPLCMT COMPL TUN CTR VAD W/PRT", "code_information": [ { "code": "36582", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7961.0, "discounted_cash": 1512.0, "minimum": 1194.15, "maximum": 6368.8, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1258.34, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 3685.8 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 1967.61 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 4101.49 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 4101.49 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1926.03, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 1797.63, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 1361.06, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2118.63, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1348.22, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1348.22, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2118.63, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1284.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1284.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 1284.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1926.03, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "PRBC", "code_information": [ { "code": "P9021", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 948.69, "minimum": 113.8425, "maximum": 758.952, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 146.83, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 224.75, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 209.76, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 158.82, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 247.22, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 157.32, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 157.32, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 247.22, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 149.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 149.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 149.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 341.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 224.75, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "ST SP/LANG/HEAR TX", "code_information": [ { "code": "92507", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 304.0, "discounted_cash": 79.0, "minimum": 45.6, "maximum": 334.4, "payers_information": [ { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 122.88, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 74.47, "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": 19.0, "median_amount": 79.42, "10th_percentile": 79.42, "90th_percentile": 79.42, "count": "1 through 10" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 74.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 74.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 81.09, "10th_percentile": 75.24, "90th_percentile": 89.2, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 79.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 111.71, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 75.0, "median_amount": 313.5, "10th_percentile": 313.5, "90th_percentile": 313.5, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 72.98, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 217.8 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 69.92 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 241.91 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 241.91 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 418.0, "10th_percentile": 418.0, "90th_percentile": 418.0, "count": "1 through 10" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 111.71, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 104.26, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 78.94, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 114.0, "10th_percentile": 114.0, "90th_percentile": 114.0, "count": "1 through 10" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 122.88, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 78.19, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 78.19, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 24.6, "median_amount": 111.01, "10th_percentile": 107.78, "90th_percentile": 137.96, "count": "15" } ] } ] }, { "description": "CT CHEST W/CONTRAST", "code_information": [ { "code": "71260", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3691.88, "discounted_cash": 701.0, "minimum": 69.8936, "maximum": 2953.504, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 69.89, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 227.2 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 736.17 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 158.53 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 227.2 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 818.17 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 818.17 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 2067.45, "10th_percentile": 2067.45, "90th_percentile": 2067.45, "count": "1 through 10" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 106.98, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 99.85, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 75.6, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 1107.56, "10th_percentile": 1107.56, "90th_percentile": 1107.56, "count": "1 through 10" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 664.54, "10th_percentile": 664.54, "90th_percentile": 787.85, "count": "1 through 10" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 117.68, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 74.89, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 240.83 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 317.99 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 74.89, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 286.75 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 227.2 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 299.99 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 117.68, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 71.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 220.58 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 701.46, "10th_percentile": 701.46, "90th_percentile": 701.46, "count": "1 through 10" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 71.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 71.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 701.46, "10th_percentile": 701.46, "90th_percentile": 701.46, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 298.8 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 106.98, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "PROXIMALOLECRANON PLATE 2.7MM", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "ALCOHOL & DRUG DEPENDENCE W REHAB OR REHABDETOX THERAPY - SOI : 1", "code_information": [ { "code": "7721", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 3594.67, "maximum": 3810.35, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 3744.68 } ] } ] }, { "description": "NEONATE BIRTHWT 500-749G WO MAJOR PROCEDURE - SOI : 2", "code_information": [ { "code": "5912", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 126493.51, "maximum": 134083.13, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 131772.21 } ] } ] }, { "description": "POISONING AND TOXIC EFFECTS OF DRUGS WITHOUT MCC", "code_information": [ { "code": "918", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 3653.2998, "maximum": 18765.0, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 4739.26 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 8217.02 } ] } ] }, { "description": "ANTIBODY ID", "code_information": [ { "code": "86870", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1875.42, "discounted_cash": 71.0, "minimum": 37.88, "maximum": 1500.336, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 142.84, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 1144.98 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 246.57 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1272.51 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 1272.51 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 218.64, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 204.06, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 154.51, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 240.5, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 153.05, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 153.05, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 24.6, "median_amount": 21.6, "10th_percentile": 21.6, "90th_percentile": 21.6, "count": "1 through 10" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 240.5, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 145.76, "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": 19.0, "median_amount": 356.33, "10th_percentile": 356.33, "90th_percentile": 356.33, "count": "1 through 10" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 145.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 145.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 37.88 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 218.64, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "HEART FAILURE - SOI : 2", "code_information": [ { "code": "1942", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 8231.27, "maximum": 8725.14, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 8574.76 } ] } ] }, { "description": "LEVAQUIN - 00143972124", "drug_information": { "unit": 100.0, "type": "ML" }, "code_information": [ { "code": "00143972124", "type": "NDC" }, { "code": "J1956", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 1.68, "10th_percentile": 1.68, "90th_percentile": 58.24, "count": "1 through 10" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 9.3, "10th_percentile": 0.57, "90th_percentile": 18.72, "count": "1 through 10" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 24.6, "median_amount": 3.84, "10th_percentile": 3.84, "90th_percentile": 4.95, "count": "1 through 10" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 24.6, "median_amount": 3.84, "10th_percentile": 3.84, "90th_percentile": 3.84, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 9.3, "10th_percentile": 0.57, "90th_percentile": 19.76, "count": "1 through 10" } ] } ] }, { "description": "CHEST PAIN - SOI : 2", "code_information": [ { "code": "2032", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 6889.47, "maximum": 7302.84, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 7176.98 } ] } ] }, { "description": "SYNCOPE & COLLAPSE - SOI : 2", "code_information": [ { "code": "2042", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 8142.45, "maximum": 8631.0, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 8482.24 } ] } ] }, { "description": "WATER ST 20ML", "code_information": [ { "code": "A4216", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 5.26, "10th_percentile": 4.98, "90th_percentile": 5.91, "count": "16" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 5.26, "10th_percentile": 5.26, "90th_percentile": 5.26, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 5.26, "10th_percentile": 5.26, "90th_percentile": 5.26, "count": "1 through 10" } ] } ] }, { "description": "INFLAMMATORY BOWEL DISEASE - SOI : 1", "code_information": [ { "code": "2451", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 8439.46, "maximum": 8945.83, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 8791.65 } ] } ] }, { "description": "NEONATE BWT 1250-1499G W RESP DIST SYNDOTH MAJ RESP OR MAJ ANOM - SOI : 2", "code_information": [ { "code": "6072", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 57121.3, "maximum": 60548.58, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 59505.02 } ] } ] }, { "description": "SCREW BNE L30M OD2.7 LOK", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "CATHETER GUIDE JR 4.5 6FR", "code_information": [ { "code": "C1725", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 462.76, "10th_percentile": 256.45, "90th_percentile": 2515.23, "count": "21" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 270.69, "10th_percentile": 106.59, "90th_percentile": 1342.29, "count": "14" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 484.0, "10th_percentile": 143.56, "90th_percentile": 543.74, "count": "1 through 10" } ] } ] }, { "description": "INTESTINAL OBSTRUCTION - SOI : 2", "code_information": [ { "code": "2472", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 7429.05, "maximum": 7874.8, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 7739.08 } ] } ] }, { "description": "CHEMO IV INFUSION 1 HR(OR)", "code_information": [ { "code": "96413", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 776.0, "discounted_cash": 147.0, "minimum": 116.4, "maximum": 620.8, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 131.63, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 387.75 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 124.48 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 430.67 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 430.67 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 201.48, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 188.05, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 142.38, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 221.63, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 141.04, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 141.04, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 221.63, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 134.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 134.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 134.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 221.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 201.48, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "STENT ONYX FRONTIER 2.75X26MM", "code_information": [ { "code": "C1874", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 4258.8, "10th_percentile": 4258.8, "90th_percentile": 4420.0, "count": "1 through 10" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1456.46, "10th_percentile": 975.0, "90th_percentile": 4680.0, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1444.95, "10th_percentile": 1444.95, "90th_percentile": 1444.95, "count": "1 through 10" } ] } ] }, { "description": "CATH NC TREK DILATION 2.50X12", "code_information": [ { "code": "C1725", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 462.76, "10th_percentile": 256.45, "90th_percentile": 2515.23, "count": "21" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 270.69, "10th_percentile": 106.59, "90th_percentile": 1342.29, "count": "14" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 484.0, "10th_percentile": 143.56, "90th_percentile": 543.74, "count": "1 through 10" } ] } ] }, { "description": "SIGNS AND SYMPTOMS OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC", "code_information": [ { "code": "555", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 6293.4104, "maximum": 28522.8, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 12782.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 12672.1 } ] } ] }, { "description": "VARIC ZOSTER AB QUAL", "code_information": [ { "code": "86787", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 207.5, "discounted_cash": 39.0, "minimum": 11.2056, "maximum": 166.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12.62, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.18 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 52.04 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 11.21 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.18 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 57.83 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 57.83 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.32, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 18.03, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 13.65, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.25, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 13.52, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.27 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.44 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.52, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 22.95 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.18 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.0 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.25, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.65 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 21.1 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.32, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "Njx aa&strd gnclr nrv brnch", "code_information": [ { "code": "64454", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4860.63, "discounted_cash": 923.0, "minimum": 112.23, "maximum": 3888.504, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 281.31, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 151.75 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 112.23 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 169.13 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 169.13 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 430.58, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 401.87, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 304.27, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 473.63, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 301.4, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 301.4, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 473.63, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 287.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 287.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 287.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 430.58, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "GUIDE CATH AR MOD 6FRCRV", "code_information": [ { "code": "C1887", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 115.24, "10th_percentile": 81.0, "90th_percentile": 503.66, "count": "23" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 156.51, "10th_percentile": 102.6, "90th_percentile": 572.45, "count": "11" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 129.36, "10th_percentile": 24.35, "90th_percentile": 512.12, "count": "1 through 10" } ] } ] }, { "description": "PALTE SEMI 5 HOLE SYNTHE", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "GUIDING CATH RCB 6FR", "code_information": [ { "code": "C1887", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 115.24, "10th_percentile": 81.0, "90th_percentile": 503.66, "count": "23" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 156.51, "10th_percentile": 102.6, "90th_percentile": 572.45, "count": "11" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 129.36, "10th_percentile": 24.35, "90th_percentile": 512.12, "count": "1 through 10" } ] } ] }, { "description": "BPD & OTH CHRONIC RESPIRATORY DISEASES ARISING IN PERINATAL PERIOD - SOI : 1", "code_information": [ { "code": "1321", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 5688.06, "maximum": 6029.35, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 5925.43 } ] } ] }, { "description": "HEART FAILURE AND SHOCK WITH MCC", "code_information": [ { "code": "291", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 6192.2762, "maximum": 29273.4, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 9227.11 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 12307.79 } ] } ] }, { "description": "STENT RESOLUTE ONYX 3.5MX38MM", "code_information": [ { "code": "C1874", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 4258.8, "10th_percentile": 4258.8, "90th_percentile": 4420.0, "count": "1 through 10" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1456.46, "10th_percentile": 975.0, "90th_percentile": 4680.0, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1444.95, "10th_percentile": 1444.95, "90th_percentile": 1444.95, "count": "1 through 10" } ] } ] }, { "description": "SHEATH SLENDER RADIAL 6FR", "code_information": [ { "code": "C1766", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 233.7, "10th_percentile": 221.4, "90th_percentile": 262.48, "count": "16" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 233.7, "10th_percentile": 233.7, "90th_percentile": 233.7, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 233.7, "10th_percentile": 233.7, "90th_percentile": 233.7, "count": "1 through 10" } ] } ] }, { "description": "FEVER AND INFLAMMATORY CONDITIONS", "code_information": [ { "code": "864", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 4040.75, "maximum": 20266.2, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 5401.15 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 8510.38 } ] } ] }, { "description": "INJ SNGL TENDON ORIGIN/INSERT", "code_information": [ { "code": "20551", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1237.4, "discounted_cash": 235.0, "minimum": 19.48, "maximum": 989.92, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 122.33, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 26.33 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 19.48 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 29.35 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 29.35 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 187.25, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 174.76, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 132.32, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 205.97, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 131.07, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.07, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 205.97, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 124.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 124.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 124.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 187.25, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "STENT RESOLUTE INTEGRITY 4.0X1", "code_information": [ { "code": "C1876", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 3100.8, "10th_percentile": 1880.29, "90th_percentile": 7522.24, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 3482.69, "10th_percentile": 3482.69, "90th_percentile": 3482.69, "count": "1 through 10" } ] } ] }, { "description": "CATH DILATION NC TREK 3.5X15MM", "code_information": [ { "code": "C1725", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 462.76, "10th_percentile": 256.45, "90th_percentile": 2515.23, "count": "21" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 270.69, "10th_percentile": 106.59, "90th_percentile": 1342.29, "count": "14" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 484.0, "10th_percentile": 143.56, "90th_percentile": 543.74, "count": "1 through 10" } ] } ] }, { "description": "CARDIOVERSION ER", "code_information": [ { "code": "92960", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2840.13, "discounted_cash": 648.0, "minimum": 263.4044, "maximum": 2729.32, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 75.0, "median_amount": 2130.1, "10th_percentile": 2130.1, "90th_percentile": 2130.1, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 263.4, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 713.49 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 380.89 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 793.96 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 793.96 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 403.17, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 376.29, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 284.91, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 443.49, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 282.22, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 282.22, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 443.49, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 268.78, "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": 19.0, "median_amount": 648.21, "10th_percentile": 648.21, "90th_percentile": 648.21, "count": "1 through 10" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 268.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 268.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 403.17, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "SIGNS, SYMPTOMS & OTHER FACTORS INFLUENCING HEALTH STATUS - SOI : 4", "code_information": [ { "code": "8614", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 30290.18, "maximum": 32107.59, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 31554.22 } ] } ] }, { "description": "IMMUNOASSAY QNT NOS NONAB(REF)", "code_information": [ { "code": "83520", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 33.63, "discounted_cash": 48.0, "minimum": 5.0445, "maximum": 585.36, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 16.92, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.37 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 33.63 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 15.02 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.37 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 33.63 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 33.63 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 121.41, "10th_percentile": 121.41, "90th_percentile": 121.41, "count": "1 through 10" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 25.91, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 24.18, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 18.31, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 28.5, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 18.13, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.83 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 33.63 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.13, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 30.76 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.37 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 32.18 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 28.5, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.66 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 12.78, "10th_percentile": 12.78, "90th_percentile": 12.78, "count": "1 through 10" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 21.19 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 25.91, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "PT NPWT <50CM 60MIN", "code_information": [ { "code": "97605", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 559.22, "discounted_cash": 77.0, "minimum": 45.315, "maximum": 900.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 79.96, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 473.52 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 152.02 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 525.94 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 525.94 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 122.39, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 114.23, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 86.49, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 1895.25, "10th_percentile": 731.62, "90th_percentile": 2268.2, "count": "1 through 10" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 196.83, "10th_percentile": 108.48, "90th_percentile": 663.21, "count": "22" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 134.62, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 85.67, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.67, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 134.62, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 81.59, "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": 19.0, "median_amount": 196.83, "10th_percentile": 196.83, "90th_percentile": 196.83, "count": "1 through 10" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 81.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 81.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 186.47, "10th_percentile": 106.25, "90th_percentile": 196.83, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 122.39, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "CATH DILATION CORONARY RX TREK", "code_information": [ { "code": "C1725", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 462.76, "10th_percentile": 256.45, "90th_percentile": 2515.23, "count": "21" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 270.69, "10th_percentile": 106.59, "90th_percentile": 1342.29, "count": "14" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 484.0, "10th_percentile": 143.56, "90th_percentile": 543.74, "count": "1 through 10" } ] } ] }, { "description": "STENT MULTILINK 3.5X15MM", "code_information": [ { "code": "C1874", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 4258.8, "10th_percentile": 4258.8, "90th_percentile": 4420.0, "count": "1 through 10" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1456.46, "10th_percentile": 975.0, "90th_percentile": 4680.0, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1444.95, "10th_percentile": 1444.95, "90th_percentile": 1444.95, "count": "1 through 10" } ] } ] }, { "description": "LCP WRIST FUSION BENDPLATE SH", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "HCG QUALITATIVE SERUM", "code_information": [ { "code": "84703", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1002.99, "discounted_cash": 190.0, "minimum": 6.5424, "maximum": 802.392, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 75.0, "median_amount": 752.24, "10th_percentile": 752.24, "90th_percentile": 752.24, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7.37, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.61 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 30.38 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 6.54 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.61 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 33.76 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 33.76 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 620.03, "10th_percentile": 561.67, "90th_percentile": 682.03, "count": "20" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11.28, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 10.53, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Gray Count Insurance MGMT Systems", "plan_name": "Gray County Insurance MGMT Systems", "methodology": "percent of total billed charges", "standard_charge_percentage": 50.0, "median_amount": 13.18, "10th_percentile": 13.18, "90th_percentile": 13.18, "count": "1 through 10" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 7.97, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 194.58, "10th_percentile": 180.54, "90th_percentile": 214.04, "count": "1 through 10" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.41, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 7.9, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.25 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.85 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.9, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange EPO/HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 27.55, "median_amount": 13.18, "10th_percentile": 13.18, "90th_percentile": 13.18, "count": "1 through 10" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 13.39 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.61 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.01 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.41, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 7.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.3 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 190.57, "10th_percentile": 190.57, "90th_percentile": 190.57, "count": "1 through 10" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 7.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 12.31 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11.28, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "STENT XIENCE ALPINE 3.0X18MM", "code_information": [ { "code": "C1874", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 4258.8, "10th_percentile": 4258.8, "90th_percentile": 4420.0, "count": "1 through 10" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1456.46, "10th_percentile": 975.0, "90th_percentile": 4680.0, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1444.95, "10th_percentile": 1444.95, "90th_percentile": 1444.95, "count": "1 through 10" } ] } ] }, { "description": "OTHER CARDIOTHORACIC PROCEDURES WITHOUT MCC", "code_information": [ { "code": "229", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 10800.0, "maximum": 36968.76, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 33149.2 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 30194.26 } ] } ] }, { "description": "TOMO MAMMO SCREEN--BILAT", "code_information": [ { "code": "77063", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 251.0, "discounted_cash": 47.0, "minimum": 11.6175, "maximum": 200.8, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 75.0, "median_amount": 188.25, "10th_percentile": 188.25, "90th_percentile": 188.25, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 21.75, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 101.93 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 21.95 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 113.28 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 113.28 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 140.56, "10th_percentile": 105.32, "90th_percentile": 170.68, "count": "29" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 33.29, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 31.07, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 23.52, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 75.3, "10th_percentile": 46.46, "90th_percentile": 75.3, "count": "43" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 49.05, "10th_percentile": 49.05, "90th_percentile": 128.68, "count": "80" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 36.61, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 23.3, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.3, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 36.61, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 22.19, "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": 19.0, "median_amount": 47.69, "10th_percentile": 47.69, "90th_percentile": 47.69, "count": "59" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 22.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 22.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 22.19 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 30.94 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 33.29, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "US EXTREM NON VASC", "code_information": [ { "code": "76881", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 856.25, "discounted_cash": 162.0, "minimum": 41.6598, "maximum": 685.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 41.66, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 141.42 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 234.4 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 50.48 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 141.42 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 260.51 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 260.51 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 63.77, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 59.51, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 45.06, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 70.14, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 44.64, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 149.9 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 197.93 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 44.64, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 178.49 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 141.42 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 186.73 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 70.14, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 42.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 137.3 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 42.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 42.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 161.48 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 63.77, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "PROTEIN S ANTIGEN TOTAL(REF)", "code_information": [ { "code": "85305", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 85.8, "discounted_cash": 16.0, "minimum": 10.1007, "maximum": 68.64, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11.38, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.39 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 46.9 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 10.1 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.39 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 52.13 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 52.13 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17.42, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 16.25, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 12.31, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.16, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.19, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.37 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.94 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.19, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 20.68 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.39 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.64 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.16, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 11.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.91 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 11.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 19.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.42, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "OTHER O.R. PROCEDURES FOR LYMPHATICHEMATOPOIETICOTHER NEOPLASMS - SOI : 4", "code_information": [ { "code": "6814", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 207054.68, "maximum": 219477.96, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 215695.27 } ] } ] }, { "description": "CS INITIAL 10-22 MINUTES", "code_information": [ { "code": "99152", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 702.63, "discounted_cash": 121.0, "minimum": 10.9707, "maximum": 562.104, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 75.0, "median_amount": 479.06, "10th_percentile": 479.06, "90th_percentile": 479.06, "count": "1 through 10" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 34.17 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 10.97 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 37.96 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 37.96 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 434.35, "10th_percentile": 393.47, "90th_percentile": 434.35, "count": "1 through 10" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 133.5, "10th_percentile": 126.47, "90th_percentile": 149.94, "count": "46" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 24.6, "median_amount": 109.07, "10th_percentile": 109.07, "90th_percentile": 109.07, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 133.5, "10th_percentile": 133.5, "90th_percentile": 133.5, "count": "31" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 133.5, "10th_percentile": 126.47, "90th_percentile": 149.94, "count": "13" } ] } ] }, { "description": "GUIDEWIRE ORTH 240MM 2MM TROC", "code_information": [ { "code": "C1769", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 228.66, "10th_percentile": 43.17, "90th_percentile": 1333.19, "count": "49" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 200.16, "10th_percentile": 45.57, "90th_percentile": 746.52, "count": "29" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 130.22, "10th_percentile": 39.18, "90th_percentile": 442.41, "count": "15" } ] } ] }, { "description": "ALCOHOL, DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITH MCC", "code_information": [ { "code": "896", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 10025.0, "maximum": 36028.8, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 10025.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 16730.27 } ] } ] }, { "description": "XR T-SPINE SCOLIOSIS", "code_information": [ { "code": "72081", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 380.0, "discounted_cash": 72.0, "minimum": 34.6822, "maximum": 358.35, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 34.68, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 112.36 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 322.43 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 69.43 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 112.36 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 358.35 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 358.35 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 212.8, "10th_percentile": 212.8, "90th_percentile": 212.8, "count": "1 through 10" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 53.09, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 49.55, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 37.51, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 114.0, "10th_percentile": 114.0, "90th_percentile": 114.0, "count": "1 through 10" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 58.39, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 37.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 119.1 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 157.26 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 37.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 141.82 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 112.36 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 148.36 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 58.39, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 35.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 109.09 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 35.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 35.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 72.96 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 53.09, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "PHOSPHATIDYLETHANOL(PETH) LC", "code_information": [ { "code": "80321", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 500.0, "discounted_cash": 95.0, "minimum": 17.64, "maximum": 400.0, "payers_information": [ { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.0 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.0 }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 90.0, "10th_percentile": 90.0, "90th_percentile": 90.0, "count": "1 through 10" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.14 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26.6 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 23.99 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.0 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.09 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.45 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 17.64 } ] } ] }, { "description": "CARDIAC ARREST & SHOCK - SOI : 4", "code_information": [ { "code": "1964", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 25716.62, "maximum": 27259.61, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 26789.8 } ] } ] }, { "description": "T3, FREE", "code_information": [ { "code": "84481", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 20.0, "discounted_cash": 59.0, "minimum": 3.0, "maximum": 251.904, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 75.0, "median_amount": 214.69, "10th_percentile": 214.69, "90th_percentile": 214.69, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 16.6, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.0 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 20.0 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 14.74 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.0 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 20.0 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 20.0 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 214.12, "10th_percentile": 176.33, "90th_percentile": 214.12, "count": "1 through 10" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 20.0, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 20.0, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 17.96, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 61.09, "10th_percentile": 16.94, "90th_percentile": 67.2, "count": "13" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 20.0, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 17.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.0 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.0 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 20.0 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.0 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.0 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.0, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "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": "fee schedule", "standard_charge_dollar": 20.0 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 59.83, "10th_percentile": 59.83, "90th_percentile": 59.83, "count": "1 through 10" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 16.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 59.83, "10th_percentile": 56.68, "90th_percentile": 67.2, "count": "11" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 20.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 20.0, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "Revise kneecap", "code_information": [ { "code": "27437", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6186.25, "discounted_cash": 1175.0, "minimum": 927.9375, "maximum": 6186.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2891.8, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 6186.25 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 4247.18 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 6186.25 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 6186.25 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4426.23, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 4131.15, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 3127.87, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4868.85, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3098.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3098.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4868.85, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2950.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2950.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 2950.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4426.23, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "NONSPECIFIC CEREBROVASCULAR DISORDERS WITHOUT CCMCC", "code_information": [ { "code": "072", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 7249.6894, "maximum": 16513.2, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 7677.57 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 7249.69 } ] } ] }, { "description": "CT CHEST W/O CONTRAST", "code_information": [ { "code": "71250", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2960.77, "discounted_cash": 562.0, "minimum": 41.6598, "maximum": 2368.616, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 41.66, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 135.95 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 452.8 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 97.51 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 135.95 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 503.24 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 503.24 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 1830.29, "10th_percentile": 1658.03, "90th_percentile": 2013.32, "count": "1 through 10" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 63.77, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 59.51, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 45.06, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 888.23, "10th_percentile": 807.48, "90th_percentile": 888.23, "count": "1 through 10" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 574.39, "10th_percentile": 532.94, "90th_percentile": 631.83, "count": "31" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 70.14, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 44.64, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 144.11 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 190.28 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 44.64, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 171.59 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 135.95 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 179.51 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 70.14, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 42.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 131.99 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 562.55, "10th_percentile": 562.55, "90th_percentile": 562.55, "count": "17" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 42.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 42.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 562.55, "10th_percentile": 532.94, "90th_percentile": 631.83, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 151.76 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 63.77, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "SCREW BNE 3.5MM LOCKING", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "LIVER TRANSPLANT &OR INTESTINAL TRANSPLANT - SOI : 1", "code_information": [ { "code": "0011", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 80612.73, "maximum": 85449.5, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 83976.78 } ] } ] }, { "description": "DRESSING OPTILOCK 4X4", "code_information": [ { "code": "A6197", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 12.24, "10th_percentile": 12.24, "90th_percentile": 16.34, "count": "1 through 10" } ] } ] }, { "description": "HLA CLASS I ANTIBODY ID", "code_information": [ { "code": "86830", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 895.95, "discounted_cash": 170.0, "minimum": 83.1024, "maximum": 716.76, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 93.61, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 134.79 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 385.9 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 83.1 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 134.79 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 428.88 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 428.88 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 143.28, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 133.73, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 101.25, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 157.61, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 100.3, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 142.87 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 188.65 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 100.3, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 170.12 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 134.79 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 177.97 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 157.61, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 95.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 130.86 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 95.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 95.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 132.18 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 143.28, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "MAJOR SKIN DISORDERS - SOI : 4", "code_information": [ { "code": "3814", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 50991.06, "maximum": 54050.53, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 53118.97 } ] } ] }, { "description": "DIABETES WITH CC", "code_information": [ { "code": "638", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 4061.0692, "maximum": 22518.0, "payers_information": [ { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "other", "standard_charge_dollar": 13500.0, "standard_charge_algorithm": "$4,500 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 9000.0, "10th_percentile": 4500.0, "90th_percentile": 22500.0, "count": "1 through 10" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 5415.69 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 8591.87 } ] } ] }, { "description": "TRLUML BALO ANGIOP 1ST ART - 37246 - 930070", "code_information": [ { "code": "37246", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 28507.6, "discounted_cash": 4830.0, "minimum": 2268.2394, "maximum": 22806.08, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2268.24, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 6588.7 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 3517.28 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 7331.79 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 7331.79 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3471.8, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 3240.34, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 2453.4, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3818.97, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2430.26, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2430.26, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3818.97, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2314.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2314.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 2314.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3471.8, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "SUTURE MNCRL 3-0 CT1 36", "code_information": [ { "code": "A4649", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 10.66, "10th_percentile": 3.56, "90th_percentile": 309.79, "count": "12" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 9.49, "10th_percentile": 3.56, "90th_percentile": 336.36, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 9.49, "10th_percentile": 8.78, "90th_percentile": 73.99, "count": "1 through 10" } ] } ] }, { "description": "TORADOL", "drug_information": { "unit": 1.0, "type": "ML" }, "code_information": [ { "code": "00409379501", "type": "NDC" }, { "code": "J1885", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 75.0, "median_amount": 20.52, "10th_percentile": 20.52, "90th_percentile": 76.08, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 18.6, "10th_percentile": 15.32, "90th_percentile": 34.49, "count": "78" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 5.84, "10th_percentile": 4.92, "90th_percentile": 11.68, "count": "122" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange EPO/HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 27.55, "median_amount": 1.25, "10th_percentile": 1.25, "90th_percentile": 41.04, "count": "1 through 10" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 24.6, "median_amount": 2.04, "10th_percentile": 1.25, "90th_percentile": 4.08, "count": "90" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 24.6, "median_amount": 4.08, "10th_percentile": 2.04, "90th_percentile": 4.08, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 5.2, "10th_percentile": 5.2, "90th_percentile": 5.2, "count": "60" } ] } ] }, { "description": "MOD.BARIUM 45MIN", "code_information": [ { "code": "92611", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 801.63, "discounted_cash": 138.0, "minimum": 78.4995, "maximum": 641.304, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 87.23, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 249.05 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 79.95 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 276.62 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 276.62 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 408.1, "10th_percentile": 408.1, "90th_percentile": 408.1, "count": "1 through 10" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 133.52, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 124.61, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 94.35, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 218.63, "10th_percentile": 218.63, "90th_percentile": 240.49, "count": "1 through 10" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 155.52, "10th_percentile": 18.44, "90th_percentile": 171.07, "count": "1 through 10" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 146.87, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 93.46, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 93.46, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 24.6, "median_amount": 198.48, "10th_percentile": 198.48, "90th_percentile": 198.48, "count": "1 through 10" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 146.87, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 89.01, "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": 19.0, "median_amount": 152.31, "10th_percentile": 138.46, "90th_percentile": 152.31, "count": "1 through 10" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 89.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 89.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 155.52, "10th_percentile": 144.29, "90th_percentile": 155.52, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 79.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 133.52, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "HIV W ONE SIGNIF HIV COND OR WO SIGNIF RELATED COND - SOI : 3", "code_information": [ { "code": "8943", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 14625.08, "maximum": 15502.59, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 15235.4 } ] } ] }, { "description": "FOOT & TOE PROCEDURES - SOI : 1", "code_information": [ { "code": "3141", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 12822.02, "maximum": 13591.34, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 13357.09 } ] } ] }, { "description": "EATING DISORDERS - SOI : 2", "code_information": [ { "code": "7592", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 18313.35, "maximum": 19412.15, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 19077.58 } ] } ] }, { "description": "INTERSTITIAL LUNG DISEASE WITH CC", "code_information": [ { "code": "197", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 4643.8608, "maximum": 21767.4, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 7972.6 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 9099.02 } ] } ] }, { "description": "HAND & WRIST PROCEDURES - SOI : 4", "code_information": [ { "code": "3164", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 50915.62, "maximum": 53970.55, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 53040.37 } ] } ] }, { "description": "LCKNG SCRW SLF TPNG/STARDRIVE3", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "2.7 CORTEX SCREW 18", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "OTHER ENDOCRINE DISORDERS - SOI : 1", "code_information": [ { "code": "4241", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 8189.25, "maximum": 8680.6, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 8530.99 } ] } ] }, { "description": "CATHETER INFUSION 5FR 135CM", "code_information": [ { "code": "C1887", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 115.24, "10th_percentile": 81.0, "90th_percentile": 503.66, "count": "23" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 156.51, "10th_percentile": 102.6, "90th_percentile": 572.45, "count": "11" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 129.36, "10th_percentile": 24.35, "90th_percentile": 512.12, "count": "1 through 10" } ] } ] }, { "description": "LYME DISEASE", "code_information": [ { "code": "86618", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 421.09, "discounted_cash": 41.0, "minimum": 14.8161, "maximum": 336.872, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 16.69, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.04 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 68.8 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 14.82 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.04 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 76.46 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 76.46 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 25.55, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 23.84, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 18.05, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 28.1, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 17.88, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.48 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 33.65 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.88, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 30.34 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.04 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.74 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 28.1, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 17.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.34 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 17.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 17.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 27.89 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 25.55, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "ACETABLAR SHELL LINER 54MM", "code_information": [ { "code": "C1776", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 4588.1, "10th_percentile": 1617.12, "90th_percentile": 11630.3, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 9120.0, "10th_percentile": 9120.0, "90th_percentile": 9120.0, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 8640.0, "10th_percentile": 8640.0, "90th_percentile": 9120.0, "count": "1 through 10" } ] } ] }, { "description": "US LT BREAST", "code_information": [ { "code": "76641", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 778.75, "discounted_cash": 147.0, "minimum": 41.6598, "maximum": 838.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 41.66, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 135.95 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 452.8 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 97.51 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 135.95 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 503.24 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 503.24 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 63.77, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 59.51, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 45.06, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 70.14, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 44.64, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 144.11 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 190.28 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 44.64, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 171.59 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 135.95 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 179.51 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 70.14, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 42.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 131.99 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 42.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 42.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 109.99 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 63.77, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "PLATES 5&6 HOLE", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "CMPNT TIB 80X48X25MM 14MM RMD", "code_information": [ { "code": "C1776", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 4588.1, "10th_percentile": 1617.12, "90th_percentile": 11630.3, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 9120.0, "10th_percentile": 9120.0, "90th_percentile": 9120.0, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 8640.0, "10th_percentile": 8640.0, "90th_percentile": 9120.0, "count": "1 through 10" } ] } ] }, { "description": "CORTEX SCREW SELF TAP 3.5X18", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "AMISTEM C SZ 3 LAT OFFSET", "code_information": [ { "code": "C1776", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 4588.1, "10th_percentile": 1617.12, "90th_percentile": 11630.3, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 9120.0, "10th_percentile": 9120.0, "90th_percentile": 9120.0, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 8640.0, "10th_percentile": 8640.0, "90th_percentile": 9120.0, "count": "1 through 10" } ] } ] }, { "description": "MESH BARD SMALL PERFIX", "code_information": [ { "code": "C1781", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1862.28, "10th_percentile": 1862.28, "90th_percentile": 11852.02, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1206.78, "10th_percentile": 1206.78, "90th_percentile": 1206.78, "count": "1 through 10" } ] } ] }, { "description": "MITIFMESH NW IMPLANT", "code_information": [ { "code": "C1781", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1862.28, "10th_percentile": 1862.28, "90th_percentile": 11852.02, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1206.78, "10th_percentile": 1206.78, "90th_percentile": 1206.78, "count": "1 through 10" } ] } ] }, { "description": "CANC SCREW 2322-22", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "OTHER RESPIRATORY & CHEST PROCEDURES - SOI : 1", "code_information": [ { "code": "1211", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 16952.45, "maximum": 17969.6, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 17659.9 } ] } ] }, { "description": "MAJOR RESPIRATORY & CHEST PROCEDURES - SOI : 4", "code_information": [ { "code": "1204", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 95998.96, "maximum": 101758.9, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 100005.09 } ] } ] }, { "description": "GUIDE LINER 6FR", "code_information": [ { "code": "C1769", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 228.66, "10th_percentile": 43.17, "90th_percentile": 1333.19, "count": "49" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 200.16, "10th_percentile": 45.57, "90th_percentile": 746.52, "count": "29" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 130.22, "10th_percentile": 39.18, "90th_percentile": 442.41, "count": "15" } ] } ] }, { "description": "NEONATE BWT 2000-2499G, NORMAL NEWBORN OR NEONATE W OTHER PROBLEM - SOI : 4", "code_information": [ { "code": "6264", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 41117.17, "maximum": 43584.2, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 42833.03 } ] } ] }, { "description": "MALNUTRITION, FAILURE TO THRIVE & OTHER NUTRITIONAL DISORDERS - SOI : 4", "code_information": [ { "code": "4214", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 48298.88, "maximum": 51196.81, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 50314.44 } ] } ] }, { "description": "CATH QUANTUM 12MM X 2.5M - C1725 - 050080", "code_information": [ { "code": "C1725", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 462.76, "10th_percentile": 256.45, "90th_percentile": 2515.23, "count": "21" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 270.69, "10th_percentile": 106.59, "90th_percentile": 1342.29, "count": "14" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 484.0, "10th_percentile": 143.56, "90th_percentile": 543.74, "count": "1 through 10" } ] } ] }, { "description": "OTHER MAJOR HEAD & NECK PROCEDURES - SOI : 3", "code_information": [ { "code": "0913", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 61700.59, "maximum": 65402.62, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 64275.41 } ] } ] }, { "description": "CORONARY BYPASS W AMI OR COMPLEX PDX - SOI : 3", "code_information": [ { "code": "1653", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 61180.11, "maximum": 64850.91, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 63733.21 } ] } ] }, { "description": "STENT XIENCE ALPINE 3.25X15MM", "code_information": [ { "code": "C1874", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 4258.8, "10th_percentile": 4258.8, "90th_percentile": 4420.0, "count": "1 through 10" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1456.46, "10th_percentile": 975.0, "90th_percentile": 4680.0, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1444.95, "10th_percentile": 1444.95, "90th_percentile": 1444.95, "count": "1 through 10" } ] } ] }, { "description": "STENT INTEGRITY RX 2.75X12", "code_information": [ { "code": "C1876", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 3100.8, "10th_percentile": 1880.29, "90th_percentile": 7522.24, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 3482.69, "10th_percentile": 3482.69, "90th_percentile": 3482.69, "count": "1 through 10" } ] } ] }, { "description": "STIMULAN CALC SULF BONE FILLER", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "SQ IMMUNIZATION INJECTIO", "code_information": [ { "code": "90471", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 337.32, "discounted_cash": 12.0, "minimum": 10.119, "maximum": 269.856, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 75.0, "median_amount": 252.99, "10th_percentile": 252.99, "90th_percentile": 252.99, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 28.69, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 163.87 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 52.61 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 182.01 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 182.01 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 188.9, "10th_percentile": 188.9, "90th_percentile": 229.38, "count": "1 through 10" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 43.92, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 40.99, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 31.04, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 64.09, "10th_percentile": 16.27, "90th_percentile": 71.98, "count": "19" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 48.31, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 30.74, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30.74, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 48.31, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 29.28, "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": 24.6, "median_amount": 15.25, "10th_percentile": 15.25, "90th_percentile": 67.46, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 64.09, "10th_percentile": 64.09, "90th_percentile": 64.09, "count": "12" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 29.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 29.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 32.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 43.92, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "MRI LT UPPER EXT JNT W/CONTRAS", "code_information": [ { "code": "73222", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4966.0, "discounted_cash": 943.0, "minimum": 312.4142, "maximum": 3972.8, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 312.41, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 990.07 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 2750.51 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 592.31 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 990.07 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 3056.88 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 3056.88 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 478.19, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 446.31, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 337.92, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 526.0, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 334.73, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1049.47 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1385.71 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 334.73, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 1249.6 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 990.07 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1307.27 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 526.0, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 318.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 961.23 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 318.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 318.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 511.79 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 478.19, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "INGUINAL AND FEMORAL HERNIA PROCEDURES WITH MCC", "code_information": [ { "code": "350", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 11325.1832, "maximum": 36779.4, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 22959.2 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 23889.85 } ] } ] }, { "description": "IVC ANGIOGRAM", "code_information": [ { "code": "75825", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5468.75, "discounted_cash": 1039.0, "minimum": 820.3125, "maximum": 5468.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1258.34, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3941.43 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 5468.75 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2411.01 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3941.43 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 5468.75 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 5468.75 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1926.03, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 1797.63, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 1361.06, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2118.63, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1348.22, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4177.91 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5468.75 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1348.22, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 4974.62 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3941.43 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5204.22 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2118.63, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1284.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3826.63 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1284.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 1284.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 3091.73 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1926.03, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "CATH AMPL 7FR", "code_information": [ { "code": "C1887", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 115.24, "10th_percentile": 81.0, "90th_percentile": 503.66, "count": "23" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 156.51, "10th_percentile": 102.6, "90th_percentile": 572.45, "count": "11" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 129.36, "10th_percentile": 24.35, "90th_percentile": 512.12, "count": "1 through 10" } ] } ] }, { "description": "ALDOSTERONE RENIN RATIO (PRA)", "code_information": [ { "code": "82088", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 40.75, "discounted_cash": 78.0, "minimum": 6.1125, "maximum": 329.784, "payers_information": [ { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 40.75 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 40.75 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 40.75 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 40.75 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 40.75 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "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": "fee schedule", "standard_charge_dollar": 40.75 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 40.75 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 39.94, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 40.75 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 40.75 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 35.45 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 40.75 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 40.75 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 40.75 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 230.85, "10th_percentile": 230.85, "90th_percentile": 230.85, "count": "1 through 10" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "5-HIAA,Quant.,24 Hr Urine", "code_information": [ { "code": "83497", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 81.5, "discounted_cash": 15.0, "minimum": 11.223, "maximum": 65.2, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12.64, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.2 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 52.12 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 11.22 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.2 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 57.92 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 57.92 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.35, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 18.06, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 13.67, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.29, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 13.55, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.29 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.47 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.55, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 22.97 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.2 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.03 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.29, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.67 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 21.11 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.35, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "COLONOSCOPY THRU STOMA DIAG", "code_information": [ { "code": "44388", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2924.2, "discounted_cash": 555.0, "minimum": 370.6164, "maximum": 2339.36, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 370.62, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 1015.96 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 542.35 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 1130.54 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 1130.54 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 567.27, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 529.45, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 400.87, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 624.0, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 397.09, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 397.09, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 624.0, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 378.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 378.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 378.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 567.27, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "TC99M HMPAO (CERETEC)", "code_information": [ { "code": "A9569", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8040.72, "minimum": 915.4474, "maximum": 6432.576, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 915.45, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 3668.85 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1261.62 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 4074.89 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 4074.89 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1401.2, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 1307.78, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 990.18, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1541.31, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 980.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 980.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1541.31, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 934.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 934.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 934.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 990.18 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1401.2, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "VITAMIN D, TOTAL", "code_information": [ { "code": "82306", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 162.8, "discounted_cash": 57.0, "minimum": 21.0, "maximum": 240.304, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 75.0, "median_amount": 111.0, "10th_percentile": 111.0, "90th_percentile": 122.1, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 29.01, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 41.78 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 119.58 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 25.75 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 41.78 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 132.9 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 132.9 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 110.7, "10th_percentile": 91.17, "90th_percentile": 110.7, "count": "47" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 44.4, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 41.44, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 31.38, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 231.58, "10th_percentile": 231.58, "90th_percentile": 231.58, "count": "1 through 10" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 30.93, "10th_percentile": 29.3, "90th_percentile": 34.74, "count": "61" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 48.84, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 31.08, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 44.28 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 58.47 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 31.08, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 52.73 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 41.78 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 55.16 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 48.84, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "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": "fee schedule", "standard_charge_dollar": 40.56 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 30.93, "10th_percentile": 29.6, "90th_percentile": 30.93, "count": "51" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 29.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 29.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 30.93, "10th_percentile": 29.3, "90th_percentile": 34.74, "count": "16" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 48.48 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 44.4, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "HYDRATION IV INFUSION INIT (31 - 96360 - 060010", "code_information": [ { "code": "96360", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 998.59, "discounted_cash": 65.0, "minimum": 33.5472, "maximum": 798.872, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 84.76, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 104.5 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 33.55 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 116.07 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 116.07 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 129.74, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 121.09, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 91.68, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 189.73, "10th_percentile": 124.45, "90th_percentile": 998.59, "count": "13" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 142.71, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 90.81, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 90.81, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 142.71, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 86.49, "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": 19.0, "median_amount": 189.73, "10th_percentile": 179.75, "90th_percentile": 189.73, "count": "1 through 10" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 86.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 86.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 189.73, "10th_percentile": 179.75, "90th_percentile": 213.1, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 129.74, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "Varicella Zoster Virus DNA PCR - 87798 - 800629", "code_information": [ { "code": "87798", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 50.0, "discounted_cash": 33.0, "minimum": 7.5, "maximum": 749.52, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 34.39, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 49.51 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 50.0 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 30.53 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 49.51 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 50.0 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 50.0 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 50.0, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 49.13, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 37.2, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 50.0, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 36.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 50.0 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 50.0 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 50.0 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 49.51 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 50.0 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 50.0, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 48.07 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 50.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 50.0, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "HEADACHES WITH MCC", "code_information": [ { "code": "102", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 5318.5506, "maximum": 23268.6, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 9641.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 10746.07 } ] } ] }, { "description": "STENT XIENCE XPEDITION 3.0X23M", "code_information": [ { "code": "C1874", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 4258.8, "10th_percentile": 4258.8, "90th_percentile": 4420.0, "count": "1 through 10" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1456.46, "10th_percentile": 975.0, "90th_percentile": 4680.0, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1444.95, "10th_percentile": 1444.95, "90th_percentile": 1444.95, "count": "1 through 10" } ] } ] }, { "description": "BASE PLATE LG L-2", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "RMVL DEVITAL TIS 20 CM/<(OR)", "code_information": [ { "code": "97597", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 445.7, "discounted_cash": 196.0, "minimum": 21.3237, "maximum": 828.744, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 79.96, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 66.42 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 21.32 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 73.78 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 73.78 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 122.39, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 114.23, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 86.49, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 134.62, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 85.67, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.67, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 134.62, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 81.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 81.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 81.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 122.39, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "FEMALE REPRODUCTIVE SYSTEM INFECTIONS - SOI : 2", "code_information": [ { "code": "5312", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 8392.66, "maximum": 8896.22, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 8742.9 } ] } ] }, { "description": "MONORAIL STENT 28MMX2.75", "code_information": [ { "code": "C1876", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 3100.8, "10th_percentile": 1880.29, "90th_percentile": 7522.24, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 3482.69, "10th_percentile": 3482.69, "90th_percentile": 3482.69, "count": "1 through 10" } ] } ] }, { "description": "NEONATE BIRTHWT >2499G W OTHER SIGNIFICANT CONDITION - SOI : 1", "code_information": [ { "code": "6391", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 6881.83, "maximum": 7294.74, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 7169.02 } ] } ] }, { "description": "MENTAL ILLNESS DIAGNOSIS W O.R. PROCEDURE - SOI : 3", "code_information": [ { "code": "7403", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 37694.4, "maximum": 39956.07, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 39267.43 } ] } ] }, { "description": "ST DYSPHAGIA TX", "code_information": [ { "code": "92526", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 284.8, "discounted_cash": 40.0, "minimum": 31.6305, "maximum": 264.7, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 80.5, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 238.32 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 76.51 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 264.7 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 264.7 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 123.21, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 115.0, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 87.07, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 126.52, "10th_percentile": 126.52, "90th_percentile": 126.52, "count": "1 through 10" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 45.0, "10th_percentile": 45.0, "90th_percentile": 45.0, "count": "1 through 10" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 135.53, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 86.25, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 86.25, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 135.53, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 82.14, "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": 19.0, "median_amount": 45.46, "10th_percentile": 45.46, "90th_percentile": 45.46, "count": "1 through 10" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 82.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 82.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 45.0, "10th_percentile": 45.0, "90th_percentile": 45.0, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 79.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 123.21, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "CIRCUMCISION NEONATE-28 DAYS<", "code_information": [ { "code": "54160", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1978.32, "discounted_cash": 375.0, "minimum": 277.879, "maximum": 1582.656, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 277.88, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 740.18 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 395.14 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 823.66 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 823.66 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 425.33, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 396.97, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 300.56, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 467.86, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 297.73, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 297.73, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 467.86, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 283.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 283.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 283.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 425.33, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "MAJOR ESOPHAGEAL DISORDERS WITHOUT CCMCC", "code_information": [ { "code": "370", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 3452.4168, "maximum": 15012.0, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 5815.04 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 6718.57 } ] } ] }, { "description": "PROXIMAL TENODESIS IMPLANT", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "CANC SCREW 2332-90", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "ACETABULAR SHELL LINER 58MM", "code_information": [ { "code": "C1776", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 4588.1, "10th_percentile": 1617.12, "90th_percentile": 11630.3, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 9120.0, "10th_percentile": 9120.0, "90th_percentile": 9120.0, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 8640.0, "10th_percentile": 8640.0, "90th_percentile": 9120.0, "count": "1 through 10" } ] } ] }, { "description": "XR LEG LENGTH SURVEY", "code_information": [ { "code": "77073", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 417.61, "discounted_cash": 79.0, "minimum": 41.6598, "maximum": 552.904, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 41.66, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 135.95 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 417.61 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 97.51 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 135.95 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 417.61 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 417.61 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 63.77, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 59.51, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 45.06, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 70.14, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 44.64, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 144.11 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 190.28 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 44.64, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 171.59 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 135.95 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 179.51 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 70.14, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 42.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 131.99 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 42.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 42.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 68.82 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 63.77, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "BIO-COMP SWVLK C,CDL 4.75X19.1", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "CATHETER EUPHORA RX 2.25 X 20M", "code_information": [ { "code": "C1725", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 462.76, "10th_percentile": 256.45, "90th_percentile": 2515.23, "count": "21" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 270.69, "10th_percentile": 106.59, "90th_percentile": 1342.29, "count": "14" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 484.0, "10th_percentile": 143.56, "90th_percentile": 543.74, "count": "1 through 10" } ] } ] }, { "description": "SCREW 4.0X68 SHORT THREAD", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "SURGIME SH TINTRACK7", "code_information": [ { "code": "C1781", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1862.28, "10th_percentile": 1862.28, "90th_percentile": 11852.02, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1206.78, "10th_percentile": 1206.78, "90th_percentile": 1206.78, "count": "1 through 10" } ] } ] }, { "description": "SOLU-MEDROL - 63323025503", "drug_information": { "unit": 40.0, "type": "ME" }, "code_information": [ { "code": "63323025503", "type": "NDC" }, { "code": "J2919", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 75.0, "median_amount": 40.38, "10th_percentile": 36.48, "90th_percentile": 40.38, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 36.61, "10th_percentile": 27.24, "90th_percentile": 36.61, "count": "1 through 10" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 11.49, "10th_percentile": 9.69, "90th_percentile": 29.07, "count": "58" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 24.6, "median_amount": 7.95, "10th_percentile": 3.07, "90th_percentile": 8.83, "count": "27" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 10.23, "10th_percentile": 10.23, "90th_percentile": 18.48, "count": "26" } ] } ] }, { "description": "FIXATION MENSICAL CINCH", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "OPEN CRANIOTOMY EXCEPT TRAUMA- SOI : 1", "code_information": [ { "code": "0211", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 27127.17, "maximum": 28754.8, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 28259.22 } ] } ] }, { "description": "ALLOGENEIC BONE MARROW TRANSPLANT- SOI : 1", "code_information": [ { "code": "0071", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 109848.58, "maximum": 116439.49, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 114432.66 } ] } ] }, { "description": "OTHER SKIN, SUBCUTANEOUS TISSUE & RELATED PROCEDURES - SOI : 1", "code_information": [ { "code": "3641", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 8215.99, "maximum": 8708.94, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 8558.85 } ] } ] }, { "description": "HYPERTENSION WITH MCC", "code_information": [ { "code": "304", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 5059.4808, "maximum": 23268.6, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 9436.62 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 11408.53 } ] } ] }, { "description": "OBSERVATION FIRST HOUR(MS)", "code_information": [ { "code": "G0378", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 450.0, "minimum": 67.5, "maximum": 937.5, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 450.0 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 450.0 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 450.0 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 450.0 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 5952.86, "10th_percentile": 3978.0, "90th_percentile": 8568.0, "count": "16" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 2916.0, "10th_percentile": 792.25, "90th_percentile": 5185.62, "count": "201" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 24.6, "median_amount": 4723.2, "10th_percentile": 2899.66, "90th_percentile": 13219.2, "count": "13" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 24.6, "median_amount": 2720.46, "10th_percentile": 2720.46, "90th_percentile": 11750.4, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 2137.5, "10th_percentile": 769.5, "90th_percentile": 4104.0, "count": "90" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 2310.74, "10th_percentile": 1117.48, "90th_percentile": 4941.0, "count": "64" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 450.0 } ] } ] }, { "description": "OTHER INJURY, POISONING & TOXIC EFFECT DIAGNOSES - SOI : 4", "code_information": [ { "code": "8154", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 62178.1, "maximum": 65908.78, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 64772.85 } ] } ] }, { "description": "Treat metatarsal fracture", "code_information": [ { "code": "28485", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 21250.0, "discounted_cash": 4037.0, "minimum": 2891.8036, "maximum": 17000.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2891.8, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 7955.99 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 4247.18 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 8853.29 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 8853.29 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4426.23, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 4131.15, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 3127.87, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4868.85, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3098.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3098.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4868.85, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2950.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2950.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 2950.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4426.23, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "STEM NATURAL HIP RT SZ2", "code_information": [ { "code": "C1776", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 4588.1, "10th_percentile": 1617.12, "90th_percentile": 11630.3, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 9120.0, "10th_percentile": 9120.0, "90th_percentile": 9120.0, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 8640.0, "10th_percentile": 8640.0, "90th_percentile": 9120.0, "count": "1 through 10" } ] } ] }, { "description": "OT WHEEL CHAIR TM 15MIN", "code_information": [ { "code": "97542", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 109.0, "discounted_cash": 20.0, "minimum": 16.35, "maximum": 120.584, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 29.67, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 91.81 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 29.48 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 101.98 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 101.98 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 45.42, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 42.39, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 32.1, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 49.96, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 31.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 31.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 49.96, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 30.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 30.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 30.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 79.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 45.42, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "BONE SCREW LCP L45MX3.5M", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "GUIDEWIRE .35X150CM", "code_information": [ { "code": "C1769", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 228.66, "10th_percentile": 43.17, "90th_percentile": 1333.19, "count": "49" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 200.16, "10th_percentile": 45.57, "90th_percentile": 746.52, "count": "29" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 130.22, "10th_percentile": 39.18, "90th_percentile": 442.41, "count": "15" } ] } ] }, { "description": "PLATE EPI OBLQ RT SM", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "BLOOD ADMINISTRATION - 36430 - 009043", "code_information": [ { "code": "36430", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1940.2, "discounted_cash": 244.0, "minimum": 24.86, "maximum": 1823.408, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 175.82, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 33.61 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 24.86 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 37.46 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 37.46 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 269.12, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 251.17, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 190.17, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 410.27, "10th_percentile": 341.89, "90th_percentile": 486.39, "count": "1 through 10" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 296.03, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 188.38, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 188.38, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 296.03, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 179.41, "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": 19.0, "median_amount": 433.06, "10th_percentile": 433.06, "90th_percentile": 433.06, "count": "1 through 10" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 179.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 179.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 410.27, "10th_percentile": 410.27, "90th_percentile": 410.27, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 269.12, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "DRUG & ALCOHOL ABUSE OR DEPENDENCE, LEFT AGAINST MEDICAL ADVICE - SOI : 2", "code_information": [ { "code": "7702", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 4342.45, "maximum": 4603.0, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 4523.66 } ] } ] }, { "description": "COMPRESSION SCRW LNG 2.4X23", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "GLIDEWIRE 035X150 ANGL", "code_information": [ { "code": "C1769", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 228.66, "10th_percentile": 43.17, "90th_percentile": 1333.19, "count": "49" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 200.16, "10th_percentile": 45.57, "90th_percentile": 746.52, "count": "29" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 130.22, "10th_percentile": 39.18, "90th_percentile": 442.41, "count": "15" } ] } ] }, { "description": "Treat finger fracture each - 26742 - OR36026742", "code_information": [ { "code": "26742", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1767.5, "discounted_cash": 1454.0, "minimum": 265.125, "maximum": 6125.32, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 640.82, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 1767.5 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 962.33 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 1767.5 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 1767.5 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 980.85, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 915.46, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 693.13, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1078.94, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 686.6, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 686.6, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1078.94, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 653.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 653.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 653.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 980.85, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "OTHER INFECTIOUS AND PARASITIC DISEASES DIAGNOSES WITHOUT CCMCC", "code_information": [ { "code": "869", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 3352.668, "maximum": 18014.4, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 5377.2 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 6995.63 } ] } ] }, { "description": "2.4MM CORTEX SCREW 30MM", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "SCRW BNE 6.5MMX55MM", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "GASTROINTESTINAL VASCULAR INSUFFICIENCY - SOI : 3", "code_information": [ { "code": "2463", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 18514.86, "maximum": 19625.75, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 19287.5 } ] } ] }, { "description": "OT THERAPY GROUP 30MIN", "code_information": [ { "code": "97150", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 235.0, "discounted_cash": 44.0, "minimum": 7.05, "maximum": 188.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17.25, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 50.79 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 16.3 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 56.41 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 56.41 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 26.4, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 24.64, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 18.66, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 29.04, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 18.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 29.04, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 17.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 17.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 17.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 79.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 26.4, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "STRAPPING OF KNEE - 29530 - 007074", "code_information": [ { "code": "29530", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 395.0, "discounted_cash": 93.0, "minimum": 45.9825, "maximum": 395.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 53.02, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 145.01 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 77.41 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 161.36 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 161.36 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 81.15, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 75.74, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 57.35, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 71.1, "10th_percentile": 71.1, "90th_percentile": 71.1, "count": "1 through 10" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 89.27, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 56.81, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 56.81, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 24.6, "median_amount": 101.12, "10th_percentile": 101.12, "90th_percentile": 268.6, "count": "1 through 10" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 89.27, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 54.1, "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": 19.0, "median_amount": 75.05, "10th_percentile": 75.05, "90th_percentile": 75.05, "count": "1 through 10" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 54.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 54.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 84.29, "10th_percentile": 84.29, "90th_percentile": 84.29, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 81.15, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "MESH PHASIX 4ö X 6ö", "code_information": [ { "code": "C1781", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1862.28, "10th_percentile": 1862.28, "90th_percentile": 11852.02, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1206.78, "10th_percentile": 1206.78, "90th_percentile": 1206.78, "count": "1 through 10" } ] } ] }, { "description": "Iodine, serum or plasma", "code_information": [ { "code": "83789", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 225.0, "discounted_cash": 42.0, "minimum": 20.9757, "maximum": 180.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 23.63, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 34.02 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 97.4 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 20.98 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 34.02 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 108.25 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 108.25 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 126.0, "10th_percentile": 126.0, "90th_percentile": 126.0, "count": "1 through 10" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 36.17, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 33.75, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 25.56, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 39.78, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 25.32, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 36.06 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 47.62 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.32, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 42.94 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 34.02 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 44.92 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 39.78, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "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": "fee schedule", "standard_charge_dollar": 33.03 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 24.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 24.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 42.75, "10th_percentile": 42.75, "90th_percentile": 42.75, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 29.56 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 36.17, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "Incision of rectal abscess", "code_information": [ { "code": "46040", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2651.25, "discounted_cash": 503.0, "minimum": 397.6875, "maximum": 4054.928, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 476.89, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 1335.61 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 713.0 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 1486.25 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 1486.25 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 729.93, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 681.27, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 515.82, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 802.92, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 510.95, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 510.95, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 802.92, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 486.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 486.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 486.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 729.93, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "TRANSURETHRAL PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "670", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 4509.477, "maximum": 14261.4, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 9071.47 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 9369.38 } ] } ] }, { "description": "MRI RT UPPER EXT NON JNT W/WO", "code_information": [ { "code": "73220", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3785.0, "discounted_cash": 719.0, "minimum": 139.0326, "maximum": 3028.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 139.03, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 475.54 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 1542.67 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 332.21 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 475.54 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1714.51 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 1714.51 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 212.81, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 198.62, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 150.38, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 1135.5, "10th_percentile": 1135.5, "90th_percentile": 1135.5, "count": "1 through 10" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 234.09, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 148.96, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 504.07 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 665.57 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 148.96, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 600.2 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 475.54 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 627.9 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 234.09, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 141.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 461.69 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 141.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 141.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 591.5 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 212.81, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "SCREW LOCK IC FULL 5X40", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "CATH SPRINTER LEGEND 3.0X15MM", "code_information": [ { "code": "C1725", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 462.76, "10th_percentile": 256.45, "90th_percentile": 2515.23, "count": "21" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 270.69, "10th_percentile": 106.59, "90th_percentile": 1342.29, "count": "14" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 484.0, "10th_percentile": 143.56, "90th_percentile": 543.74, "count": "1 through 10" } ] } ] }, { "description": "REHABILITATION - SOI : 2", "code_information": [ { "code": "8602", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 11751.45, "maximum": 12456.53, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 12241.85 } ] } ] }, { "description": "GUIDING CATH JR 4 6 FR", "code_information": [ { "code": "C1887", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 115.24, "10th_percentile": 81.0, "90th_percentile": 503.66, "count": "23" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 156.51, "10th_percentile": 102.6, "90th_percentile": 572.45, "count": "11" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 129.36, "10th_percentile": 24.35, "90th_percentile": 512.12, "count": "1 through 10" } ] } ] }, { "description": "CLAVICAL PLATE 120MM SS 3.5MM", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "FULL THICKNESS BURN WITHOUT SKIN GRAFT OR INHALATION INJURY", "code_information": [ { "code": "934", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 3112.76, "maximum": 33026.4, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 3112.76 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 21193.02 } ] } ] }, { "description": "Evaluation of speech sound pro", "code_information": [ { "code": "92522", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 937.5, "discounted_cash": 178.0, "minimum": 79.0, "maximum": 750.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 107.21, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 253.93 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 81.52 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 282.04 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 282.04 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 164.1, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 153.16, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 115.96, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 180.51, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 114.87, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.87, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 180.51, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 109.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 109.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 109.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 79.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 164.1, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "STENT ONYX FRONTIER 3.5X18MM", "code_information": [ { "code": "C1874", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 4258.8, "10th_percentile": 4258.8, "90th_percentile": 4420.0, "count": "1 through 10" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1456.46, "10th_percentile": 975.0, "90th_percentile": 4680.0, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1444.95, "10th_percentile": 1444.95, "90th_percentile": 1444.95, "count": "1 through 10" } ] } ] }, { "description": "OTHER KIDNEY AND URINARY TRACT PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "675", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 8090.736, "maximum": 21767.4, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 18821.1 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 15736.1 } ] } ] }, { "description": "PROMOS SHOULDER BODY 40M", "code_information": [ { "code": "C1776", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 4588.1, "10th_percentile": 1617.12, "90th_percentile": 11630.3, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 9120.0, "10th_percentile": 9120.0, "90th_percentile": 9120.0, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 8640.0, "10th_percentile": 8640.0, "90th_percentile": 9120.0, "count": "1 through 10" } ] } ] }, { "description": "ARTHROPLASTY GLENOHUMERAL JOIN", "code_information": [ { "code": "23470", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 50614.6, "discounted_cash": 9616.0, "minimum": 5116.5702, "maximum": 40491.68, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5116.57, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 15827.94 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 8449.5 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 17613.05 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 17613.05 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7831.49, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 7309.39, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 5534.25, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8614.63, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5482.04, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5482.04, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8614.63, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5220.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5220.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 5220.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7831.49, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "Remove tendon sheath lesion", "code_information": [ { "code": "26160", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2945.83, "discounted_cash": 559.0, "minimum": 441.8745, "maximum": 2356.664, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 640.82, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 1802.67 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 962.33 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 2005.98 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 2005.98 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 980.85, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 915.46, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 693.13, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1078.94, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 686.6, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 686.6, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1078.94, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 653.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 653.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 653.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 980.85, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "MASTECTOMY PROCEDURES - SOI : 1", "code_information": [ { "code": "3621", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 17019.3, "maximum": 18040.46, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 17729.54 } ] } ] }, { "description": "SCREW CAPTURED GOLD 5X40", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "REPAIR OF CVC FOR INFUSION", "code_information": [ { "code": "36576", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6837.0, "discounted_cash": 1299.0, "minimum": 627.347, "maximum": 5469.6, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 627.35, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 2169.4 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 1158.1 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 2414.07 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 2414.07 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 960.23, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 896.21, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 678.56, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1056.25, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 672.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 672.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1056.25, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 640.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 640.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 640.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 960.23, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "9.0MM FLIP CUTTERB II", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 168.56, "10th_percentile": 168.56, "90th_percentile": 168.56, "count": "1 through 10" } ] } ] }, { "description": "NEPHRITIS & NEPHROSIS - SOI : 4", "code_information": [ { "code": "4624", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 52947.89, "maximum": 56124.76, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 55157.45 } ] } ] }, { "description": "Phospholipase A2 Receptor Auto", "code_information": [ { "code": "83516", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 525.0, "discounted_cash": 32.0, "minimum": 4.4625, "maximum": 436.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11.3, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.26 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 46.58 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 10.03 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.26 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 51.77 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 51.77 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 94.5, "10th_percentile": 94.5, "90th_percentile": 114.75, "count": "1 through 10" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17.3, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 16.14, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 12.22, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 30.38, "10th_percentile": 5.36, "90th_percentile": 96.03, "count": "1 through 10" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.02, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.24 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.76 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 20.53 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.26 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.47 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.02, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "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": "fee schedule", "standard_charge_dollar": 15.79 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 5.65, "10th_percentile": 5.65, "90th_percentile": 5.65, "count": "1 through 10" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 18.89 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.3, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "SCREW 7.3X95MM CANNULATED", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "INFLAMMATION OF THE MALE REPRODUCTIVE SYSTEM WITHOUT MCC", "code_information": [ { "code": "728", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 3710.563, "maximum": 21767.4, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 5218.15 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 7776.97 } ] } ] }, { "description": "STENT RESOLUTE ONYX 4.5 X 26MM", "code_information": [ { "code": "C1874", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 4258.8, "10th_percentile": 4258.8, "90th_percentile": 4420.0, "count": "1 through 10" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1456.46, "10th_percentile": 975.0, "90th_percentile": 4680.0, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1444.95, "10th_percentile": 1444.95, "90th_percentile": 1444.95, "count": "1 through 10" } ] } ] }, { "description": "UTERINE & ADNEXA PROCEDURES FOR OVARIAN & ADNEXAL MALIGNANCY - SOI : 3", "code_information": [ { "code": "5113", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 31652.03, "maximum": 33551.15, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 32972.9 } ] } ] }, { "description": "STENT FRONTIER ONYX 2.25 X 30M", "code_information": [ { "code": "C1874", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 4258.8, "10th_percentile": 4258.8, "90th_percentile": 4420.0, "count": "1 through 10" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1456.46, "10th_percentile": 975.0, "90th_percentile": 4680.0, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1444.95, "10th_percentile": 1444.95, "90th_percentile": 1444.95, "count": "1 through 10" } ] } ] }, { "description": "Treat knee fracture - 27535 - OR36027535", "code_information": [ { "code": "27535", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6186.25, "discounted_cash": 1175.0, "minimum": 663.23, "maximum": 4949.0, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 1382.51 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 1382.51 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4426.23, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 4131.15, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 3127.87, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4868.85, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3098.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3098.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4868.85, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2950.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2950.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 2950.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4426.23, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2891.8, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 1242.39 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 663.23 } ] } ] }, { "description": "NONSPECIFIC CVA & PRECEREBRAL OCCLUSION WO INFARCT - SOI : 4", "code_information": [ { "code": "0464", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 22834.38, "maximum": 24204.45, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 23787.29 } ] } ] }, { "description": "THER/DIAG CONCURRENT INF(OB)", "code_information": [ { "code": "96368", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 238.78, "discounted_cash": 45.0, "minimum": 18.4962, "maximum": 1181.0, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 57.61 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 18.5 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 63.99 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 63.99 }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 45.37, "10th_percentile": 42.98, "90th_percentile": 238.78, "count": "34" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 45.37, "10th_percentile": 45.37, "90th_percentile": 45.37, "count": "12" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 45.37, "10th_percentile": 42.98, "90th_percentile": 50.96, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 238.78 } ] } ] }, { "description": "VITAMIN K1", "code_information": [ { "code": "84597", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 188.1, "discounted_cash": 35.0, "minimum": 11.9364, "maximum": 150.48, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13.45, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.36 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 55.43 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 11.94 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.36 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 61.6 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 61.6 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 20.58, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 19.21, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 14.54, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 744.91, "10th_percentile": 744.91, "90th_percentile": 744.91, "count": "1 through 10" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 22.64, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 14.41, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.53 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.1 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.41, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 24.44 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.36 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.57 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 22.64, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "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": "fee schedule", "standard_charge_dollar": 18.8 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 13.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 22.45 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 20.58, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "HEALTH BEHAVR ASMT/REASMT-905", "code_information": [ { "code": "90791", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 478.98, "discounted_cash": 91.0, "minimum": 70.7266, "maximum": 400.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 70.73, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 106.0 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 99.0 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 118.0 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 118.0 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 108.26, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 101.04, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 76.5, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 119.08, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 75.78, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 75.78, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange EPO/HMO", "methodology": "fee schedule", "standard_charge_dollar": 190.0 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 119.08, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 72.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 72.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 72.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "UBH Commercial", "methodology": "fee schedule", "standard_charge_dollar": 190.0 }, { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 130.0 }, { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicare", "methodology": "per diem", "standard_charge_dollar": 150.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 108.26, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "SCREW CANNULATED 4.0 207.634", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "D5W 250ML", "drug_information": { "unit": 250.0, "type": "ML" }, "code_information": [ { "code": "00264751020", "type": "NDC" }, { "code": "J7060", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 3.75, "10th_percentile": 3.75, "90th_percentile": 4.22, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 3.75, "10th_percentile": 3.75, "90th_percentile": 3.75, "count": "1 through 10" } ] } ] }, { "description": "OTHER DISORDERS OF NERVOUS SYSTEM - SOI : 4", "code_information": [ { "code": "0584", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 46215.99, "maximum": 48988.95, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 48144.63 } ] } ] }, { "description": "STENT RESOLUTE ONYX 2.0X15MM", "code_information": [ { "code": "C1874", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 4258.8, "10th_percentile": 4258.8, "90th_percentile": 4420.0, "count": "1 through 10" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1456.46, "10th_percentile": 975.0, "90th_percentile": 4680.0, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1444.95, "10th_percentile": 1444.95, "90th_percentile": 1444.95, "count": "1 through 10" } ] } ] }, { "description": "NPWT >50CM 60MIN", "code_information": [ { "code": "97606", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1237.0, "discounted_cash": 85.0, "minimum": 63.675, "maximum": 1666.376, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 162.0, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 101.0 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 93.0 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 112.0 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 112.0 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 247.97, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 231.43, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 175.23, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 272.76, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 173.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 272.76, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 165.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 165.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 165.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 247.97, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "MONORAIL STENT 20MMX3.0", "code_information": [ { "code": "C1874", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 4258.8, "10th_percentile": 4258.8, "90th_percentile": 4420.0, "count": "1 through 10" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1456.46, "10th_percentile": 975.0, "90th_percentile": 4680.0, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1444.95, "10th_percentile": 1444.95, "90th_percentile": 1444.95, "count": "1 through 10" } ] } ] }, { "description": "DEFIBRILLATOR IMPLANTS- SOI : 3", "code_information": [ { "code": "1793", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 52776.94, "maximum": 55943.56, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 54979.37 } ] } ] }, { "description": "CANC SCREW 2332-110", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "BPD & OTH CHRONIC RESPIRATORY DISEASES ARISING IN PERINATAL PERIOD - SOI : 3", "code_information": [ { "code": "1323", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 18188.24, "maximum": 19279.54, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 18947.25 } ] } ] }, { "description": "CATH ANGIOP L150CM L15MM O/6.0", "code_information": [ { "code": "C1725", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 462.76, "10th_percentile": 256.45, "90th_percentile": 2515.23, "count": "21" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 270.69, "10th_percentile": 106.59, "90th_percentile": 1342.29, "count": "14" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 484.0, "10th_percentile": 143.56, "90th_percentile": 543.74, "count": "1 through 10" } ] } ] }, { "description": "DISORDERS OF THE BILIARY TRACT WITH MCC", "code_information": [ { "code": "444", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 7706.5184, "maximum": 33777.0, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 11451.4 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 16018.92 } ] } ] }, { "description": "(ARTHROSCOPY)DEBRIDEMENT, EXTE", "code_information": [ { "code": "29823", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 14972.4, "discounted_cash": 2844.0, "minimum": 1303.9782, "maximum": 11977.92, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1303.98, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 3640.81 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 1943.59 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 4051.43 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 4051.43 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1995.89, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 1862.83, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 1410.43, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2195.47, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1397.12, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1397.12, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2195.47, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1330.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1330.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 1330.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1995.89, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "STENT BIL 27MM 8MM VISI-PRO 30", "code_information": [ { "code": "C1876", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 3100.8, "10th_percentile": 1880.29, "90th_percentile": 7522.24, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 3482.69, "10th_percentile": 3482.69, "90th_percentile": 3482.69, "count": "1 through 10" } ] } ] }, { "description": "RMVL DEVITAL TIS 20 CM/<", "code_information": [ { "code": "97597", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1035.93, "discounted_cash": 196.0, "minimum": 21.3237, "maximum": 828.744, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 79.96, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 101.0 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 93.0 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 112.0 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 112.0 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 122.39, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 114.23, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 86.49, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 310.78, "10th_percentile": 310.78, "90th_percentile": 932.34, "count": "1 through 10" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 186.47, "10th_percentile": 162.18, "90th_percentile": 221.07, "count": "18" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 134.62, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 85.67, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.67, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 134.62, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 81.59, "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": 19.0, "median_amount": 196.83, "10th_percentile": 196.83, "90th_percentile": 196.83, "count": "1 through 10" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 81.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 81.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 186.47, "10th_percentile": 186.47, "90th_percentile": 221.07, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 122.39, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "INJ PARAVERT F JNT L/S 1 LEV - 64493 - 004017", "code_information": [ { "code": "64493", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2636.54, "discounted_cash": 500.0, "minimum": 348.528, "maximum": 2636.544, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 352.49, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 1080.03 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 576.56 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 1201.83 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 1201.83 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 539.52, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 503.55, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 381.26, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 593.47, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 377.66, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 377.66, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 593.47, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 359.68, "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": 19.0, "median_amount": 500.94, "10th_percentile": 500.94, "90th_percentile": 500.94, "count": "1 through 10" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 359.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 359.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 539.52, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "MODERATELY EXTENSIVE OR PROCEDURES FOR OTHER COMPLICATIONS OF TREATMENT - SOI : 1", "code_information": [ { "code": "7931", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 9433.63, "maximum": 9999.65, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 9827.3 } ] } ] }, { "description": "SCREW BN 2.4X18M VA LOCK", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "SOFT TISSUE PROCEDURES WITH MCC", "code_information": [ { "code": "500", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 14564.7102, "maximum": 57045.6, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 29521.6 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 30340.94 } ] } ] }, { "description": "CARDIOVASCULAR STRESS TEST", "code_information": [ { "code": "93017", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1400.3, "discounted_cash": 345.0, "minimum": 86.0538, "maximum": 1456.4, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 75.0, "median_amount": 1365.38, "10th_percentile": 1365.38, "90th_percentile": 1365.38, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 86.05, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 685.9 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 220.2 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 761.83 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 761.83 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 1019.48, "10th_percentile": 1019.48, "90th_percentile": 1237.94, "count": "13" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 131.72, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 122.93, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 93.08, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 546.15, "10th_percentile": 546.15, "90th_percentile": 546.15, "count": "1 through 10" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 353.18, "10th_percentile": 327.69, "90th_percentile": 388.49, "count": "52" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 144.89, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 92.2, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 92.2, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 24.6, "median_amount": 41.81, "10th_percentile": 31.66, "90th_percentile": 77.79, "count": "1 through 10" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 24.6, "median_amount": 41.81, "10th_percentile": 41.81, "90th_percentile": 41.81, "count": "1 through 10" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 144.89, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 87.81, "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": 19.0, "median_amount": 345.9, "10th_percentile": 345.9, "90th_percentile": 345.9, "count": "54" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 87.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 87.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 345.9, "10th_percentile": 327.69, "90th_percentile": 388.49, "count": "11" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 709.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 131.72, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "PTCA SINGLE VESSEL", "code_information": [ { "code": "92920", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 29725.2, "discounted_cash": 5647.0, "minimum": 2268.2394, "maximum": 23780.16, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2268.24, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 8173.95 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 3517.28 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 9065.66 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 9065.66 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3471.8, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 3240.34, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 2453.4, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 5350.54, "10th_percentile": 5350.54, "90th_percentile": 5350.54, "count": "1 through 10" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3818.97, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2430.26, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2430.26, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 24.6, "median_amount": 1126.24, "10th_percentile": 1126.24, "90th_percentile": 1126.24, "count": "1 through 10" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3818.97, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2314.53, "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": 19.0, "median_amount": 5647.79, "10th_percentile": 5647.79, "90th_percentile": 5647.79, "count": "1 through 10" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2314.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 2314.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3471.8, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "STENT XIENCE ALPINE 2.75X15MM", "code_information": [ { "code": "C1874", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 4258.8, "10th_percentile": 4258.8, "90th_percentile": 4420.0, "count": "1 through 10" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1456.46, "10th_percentile": 975.0, "90th_percentile": 4680.0, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1444.95, "10th_percentile": 1444.95, "90th_percentile": 1444.95, "count": "1 through 10" } ] } ] }, { "description": "APPENDIX PROCEDURES WITH MCC", "code_information": [ { "code": "397", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 22950.0, "maximum": 38280.6, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 24872.1 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 22959.91 } ] } ] }, { "description": "EXT FIX SM CARBON ROD", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "FEMALE REPRODUCTIVE SYSTEM MALIGNANCY - SOI : 1", "code_information": [ { "code": "5301", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 8034.53, "maximum": 8516.6, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 8369.82 } ] } ] }, { "description": "ANGIOSCULPT RX PTCA TAPER 23.0", "code_information": [ { "code": "C1725", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 462.76, "10th_percentile": 256.45, "90th_percentile": 2515.23, "count": "21" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 270.69, "10th_percentile": 106.59, "90th_percentile": 1342.29, "count": "14" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 484.0, "10th_percentile": 143.56, "90th_percentile": 543.74, "count": "1 through 10" } ] } ] }, { "description": "TX DISL JT MP W/O ANES CLSD", "code_information": [ { "code": "28630", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1305.05, "discounted_cash": 247.0, "minimum": 63.29, "maximum": 1044.04, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 98.3, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 85.57 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 63.29 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 95.38 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 95.38 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 150.47, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 140.43, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 106.33, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 165.51, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 105.33, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 105.33, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 165.51, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 100.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 100.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 100.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 150.47, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "HEAVY MTL UR QUAL(REF)", "code_information": [ { "code": "83015", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 356.0, "discounted_cash": 67.0, "minimum": 18.2178, "maximum": 284.8, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 20.52, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 29.55 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 84.6 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 18.22 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 29.55 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 94.02 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 94.02 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 31.41, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 29.32, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 22.2, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 34.55, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 21.99, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.32 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 41.36 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.99, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 37.3 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 29.55 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 39.02 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 34.55, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 20.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28.69 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 20.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 20.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 30.83 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 31.41, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "MALFUNCTION, REACTION, COMPLIC OF GENITOURINARY DEVICE OR PROC - SOI : 3", "code_information": [ { "code": "4663", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 12654.89, "maximum": 13414.18, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 13182.99 } ] } ] }, { "description": "PATELIA BUTTON 20 MM", "code_information": [ { "code": "C1776", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 4588.1, "10th_percentile": 1617.12, "90th_percentile": 11630.3, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 9120.0, "10th_percentile": 9120.0, "90th_percentile": 9120.0, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 8640.0, "10th_percentile": 8640.0, "90th_percentile": 9120.0, "count": "1 through 10" } ] } ] }, { "description": "CATH GUIDE ADROIT 6FR XB3.5", "code_information": [ { "code": "C1887", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 115.24, "10th_percentile": 81.0, "90th_percentile": 503.66, "count": "23" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 156.51, "10th_percentile": 102.6, "90th_percentile": 572.45, "count": "11" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 129.36, "10th_percentile": 24.35, "90th_percentile": 512.12, "count": "1 through 10" } ] } ] }, { "description": "ANCEF 2 GM/D5W 50ML", "drug_information": { "unit": 50.0, "type": "ML" }, "code_information": [ { "code": "00264310511", "type": "NDC" }, { "code": "J0690", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 8.87, "10th_percentile": 8.87, "90th_percentile": 39.2, "count": "1 through 10" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 14.94, "10th_percentile": 3.01, "90th_percentile": 29.88, "count": "13" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 24.6, "median_amount": 2.2, "10th_percentile": 2.2, "90th_percentile": 2.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 13.3, "10th_percentile": 7.6, "90th_percentile": 53.2, "count": "1 through 10" } ] } ] }, { "description": "Moderate sedation <5yrs", "code_information": [ { "code": "99155", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 751.96, "discounted_cash": 142.0, "minimum": 79.6398, "maximum": 601.568, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 248.07 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 79.64 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 275.54 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 275.54 } ] } ] }, { "description": "CATH NC EUPHORA 3.75 X 8MM", "code_information": [ { "code": "C1725", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 462.76, "10th_percentile": 256.45, "90th_percentile": 2515.23, "count": "21" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 270.69, "10th_percentile": 106.59, "90th_percentile": 1342.29, "count": "14" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 484.0, "10th_percentile": 143.56, "90th_percentile": 543.74, "count": "1 through 10" } ] } ] }, { "description": "ORTHOPOXVIRUS AMP PRB EA", "code_information": [ { "code": "87593", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 385.0, "discounted_cash": 73.0, "minimum": 30.5283, "maximum": 308.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 50.28, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 141.76 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 30.53 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 157.55 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 157.55 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 76.97, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 71.83, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 54.39, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 84.66, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 53.88, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 53.88, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 84.66, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 51.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 51.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 51.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 61.4 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 76.97, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "URINARY STONES & ACQUIRED UPPER URINARY TRACT OBSTRUCTION - SOI : 4", "code_information": [ { "code": "4654", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 27083.24, "maximum": 28708.24, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 28213.45 } ] } ] }, { "description": "PT IONTOPHORESIS 15 MIN", "code_information": [ { "code": "97033", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 162.24, "discounted_cash": 30.0, "minimum": 3.6, "maximum": 129.792, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.13, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 57.61 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 18.5 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 63.99 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 63.99 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 110.32, "10th_percentile": 93.77, "90th_percentile": 110.32, "count": "1 through 10" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 27.75, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 25.9, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 19.61, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 30.53, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 19.43, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.43, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 30.53, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 18.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 18.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 79.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 27.75, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "OTHER EAR, NOSE, MOUTH & THROAT PROCEDURES - SOI : 2", "code_information": [ { "code": "0982", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 19128.93, "maximum": 20276.67, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 19927.2 } ] } ] }, { "description": "FRACTURE OF PELVIS OR DISLOCATION OF HIP - SOI : 3", "code_information": [ { "code": "3413", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 11913.8, "maximum": 12628.63, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 12410.97 } ] } ] }, { "description": "I & D Scrotum", "code_information": [ { "code": "55100", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4126.5, "discounted_cash": 784.0, "minimum": 618.975, "maximum": 3301.2, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 658.2, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 1825.56 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 974.55 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 2031.45 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 2031.45 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1007.45, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 940.28, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 711.93, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 784.04, "10th_percentile": 784.04, "90th_percentile": 784.04, "count": "1 through 10" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1108.19, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 705.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 705.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1108.19, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 671.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 671.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 671.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1007.45, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "OTHER PERIPHERAL VASCULAR AND RELATED PROCEDURES- SOI : 2", "code_information": [ { "code": "1822", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 27567.43, "maximum": 29221.48, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 28717.85 } ] } ] }, { "description": "STD FEMORAL STEM SZ 1", "code_information": [ { "code": "C1776", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 4588.1, "10th_percentile": 1617.12, "90th_percentile": 11630.3, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 9120.0, "10th_percentile": 9120.0, "90th_percentile": 9120.0, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 8640.0, "10th_percentile": 8640.0, "90th_percentile": 9120.0, "count": "1 through 10" } ] } ] }, { "description": "SCREW CORTICLE 3.5X20MM", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "RUSH PINS 803", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "GUIDEWIRE L260CM OD.035", "code_information": [ { "code": "C1769", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 228.66, "10th_percentile": 43.17, "90th_percentile": 1333.19, "count": "49" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 200.16, "10th_percentile": 45.57, "90th_percentile": 746.52, "count": "29" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 130.22, "10th_percentile": 39.18, "90th_percentile": 442.41, "count": "15" } ] } ] }, { "description": "DHEA", "code_information": [ { "code": "82626", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 279.13, "discounted_cash": 53.0, "minimum": 21.9849, "maximum": 223.304, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.76, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 35.66 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 102.09 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 21.98 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 35.66 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 113.46 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 113.46 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 37.91, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 35.38, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 26.79, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 41.7, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 26.53, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 37.8 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 49.91 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.53, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 45.01 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 35.66 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 47.08 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 41.7, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 25.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 34.62 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 25.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 25.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 41.38 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 37.91, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "SCREW LOW PROFILE TI 5.5X50", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "CATH POWERFLEX PRO 6X22MM", "code_information": [ { "code": "C1725", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 462.76, "10th_percentile": 256.45, "90th_percentile": 2515.23, "count": "21" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 270.69, "10th_percentile": 106.59, "90th_percentile": 1342.29, "count": "14" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 484.0, "10th_percentile": 143.56, "90th_percentile": 543.74, "count": "1 through 10" } ] } ] }, { "description": "BTB TIGHTROPE FEMORAL FIXATION", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "S-T CRTX LCK SCREW 40MM", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "TETANUS/DIPTHERIA AB PROFILE", "code_information": [ { "code": "86317", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 77.4, "discounted_cash": 2.0, "minimum": 2.2485, "maximum": 251.8, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14.69, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.16 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 60.56 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 13.04 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.16 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 67.31 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 67.31 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.49, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 20.99, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 15.89, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 24.73, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 15.74, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.43 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 29.61 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.74, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 26.7 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.16 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.93 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 24.73, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 14.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.54 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 14.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 24.54 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 22.49, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "LOCKING SCREW 3.5MM X26", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "AFTERCARE WITH CCMCC", "code_information": [ { "code": "949", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 5112.5878, "maximum": 33026.4, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 21094.9 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 11405.65 } ] } ] }, { "description": "EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS- SOI : 2", "code_information": [ { "code": "9502", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 24731.04, "maximum": 26214.91, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 25763.09 } ] } ] }, { "description": "ZOSYN 2.25 GM", "drug_information": { "unit": 2.25, "type": "GR" }, "code_information": [ { "code": "00781921095", "type": "NDC" }, { "code": "J2543", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 56.03, "10th_percentile": 46.14, "90th_percentile": 217.6, "count": "1 through 10" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 15.66, "10th_percentile": 14.83, "90th_percentile": 59.33, "count": "37" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 24.6, "median_amount": 4.65, "10th_percentile": 4.53, "90th_percentile": 18.12, "count": "1 through 10" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 24.6, "median_amount": 4.65, "10th_percentile": 4.65, "90th_percentile": 4.65, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 15.66, "10th_percentile": 15.66, "90th_percentile": 15.66, "count": "19" } ] } ] }, { "description": "SED RATE MANUAL", "code_information": [ { "code": "85651", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 148.5, "discounted_cash": 28.0, "minimum": 3.7149, "maximum": 118.8, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4.18, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.03 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 17.25 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3.71 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.03 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 19.17 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 19.17 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 91.8, "10th_percentile": 83.16, "90th_percentile": 100.98, "count": "50" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.41, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 5.98, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 4.53, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 28.22, "10th_percentile": 26.73, "90th_percentile": 31.69, "count": "42" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.05, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 4.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.39 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.43 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 7.61 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.03 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.96 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.05, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 4.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.85 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 28.22, "10th_percentile": 28.22, "90th_percentile": 28.22, "count": "43" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 4.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 28.22, "10th_percentile": 26.73, "90th_percentile": 31.69, "count": "14" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 5.81 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.41, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "I&d complex po wound infctj", "code_information": [ { "code": "10180", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3535.0, "discounted_cash": 671.0, "minimum": 530.25, "maximum": 3431.96, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1157.61, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 3084.12 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 1646.41 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 3431.96 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 3431.96 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1771.85, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 1653.72, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 1252.1, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1949.03, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1240.29, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1240.29, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1949.03, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1181.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1181.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 1181.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1771.85, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "TC99M- MDP ISOTOPE", "code_information": [ { "code": "A9503", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 638.0, "minimum": 11.2665, "maximum": 510.4, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 32.76 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 11.27 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 36.39 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 36.39 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 121.22, "10th_percentile": 121.22, "90th_percentile": 121.22, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 121.22, "10th_percentile": 121.22, "90th_percentile": 121.22, "count": "1 through 10" } ] } ] }, { "description": "RPR S/N/AX/GEN/TRNK 2.5CM/<", "code_information": [ { "code": "12001", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 941.76, "discounted_cash": 178.0, "minimum": 79.9582, "maximum": 753.408, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 79.96, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 232.39 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 124.06 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 258.6 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 258.6 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 527.39, "10th_percentile": 527.39, "90th_percentile": 640.4, "count": "1 through 10" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 122.39, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 114.23, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 86.49, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 200.98, "10th_percentile": 169.52, "90th_percentile": 941.76, "count": "1 through 10" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 134.62, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 85.67, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.67, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 24.6, "median_amount": 199.82, "10th_percentile": 194.0, "90th_percentile": 479.94, "count": "14" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 134.62, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 81.59, "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": 19.0, "median_amount": 178.93, "10th_percentile": 178.93, "90th_percentile": 178.93, "count": "1 through 10" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 81.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 81.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 188.27, "10th_percentile": 188.27, "90th_percentile": 200.97, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "percent of total billed charges", "standard_charge_percentage": 54.8, "median_amount": 291.24, "10th_percentile": 194.89, "90th_percentile": 301.98, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 122.39, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITH INTRALUMINAL DEVICE WITHOUT MCC", "code_information": [ { "code": "322", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 9000.0, "maximum": 20964.9, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 20964.9 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 16901.88 } ] } ] }, { "description": "PROT S FREE & FUNCTIONAL(REF)", "code_information": [ { "code": "85306", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 85.8, "discounted_cash": 16.0, "minimum": 9.165, "maximum": 68.79, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.01, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.62 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 61.89 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 13.33 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.62 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 68.79 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 68.79 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.98, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 21.45, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 16.24, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 25.28, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 16.09, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.92 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.26 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.09, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 27.29 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.62 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28.55 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 25.28, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.99 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 25.09 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 22.98, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "PLATE 1/3 7 HOLE 81MM", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "HYSTEROSCOPY ABLATION WO GUIDE", "code_information": [ { "code": "58563", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4679.36, "discounted_cash": 889.0, "minimum": 701.904, "maximum": 4679.36, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1993.61, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 4679.36 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 3032.79 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 4679.36 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 4679.36 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3051.45, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 2848.02, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 2156.36, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3356.6, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2136.02, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2136.02, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3356.6, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2034.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2034.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 2034.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3051.45, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "GENTAMICIN TROUGH", "code_information": [ { "code": "80170", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 234.0, "discounted_cash": 44.0, "minimum": 14.2506, "maximum": 234.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 16.05, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.11 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 66.18 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 14.25 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.11 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 73.55 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 73.55 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.57, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 22.93, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 17.36, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 292.5, "10th_percentile": 292.5, "90th_percentile": 292.5, "count": "1 through 10" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 27.03, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 17.2, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.5 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 32.35 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.2, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 29.17 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.11 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.52 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 27.03, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 16.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.44 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 16.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 26.83 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 24.57, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "PLASMIN/FIBRINOLYTIC PLASMIN", "code_information": [ { "code": "85400", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 150.63, "discounted_cash": 28.0, "minimum": 6.7077, "maximum": 120.504, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7.56, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.88 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 31.15 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 6.71 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.88 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 34.62 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 34.62 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11.57, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 10.79, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 8.17, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.72, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 8.1, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.53 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.22 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.1, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 13.73 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.88 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.36 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.72, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 7.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.56 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 7.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 14.48 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11.57, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "STENT RESOLUTE ONYX 3.5X26MM", "code_information": [ { "code": "C1874", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 4258.8, "10th_percentile": 4258.8, "90th_percentile": 4420.0, "count": "1 through 10" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1456.46, "10th_percentile": 975.0, "90th_percentile": 4680.0, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1444.95, "10th_percentile": 1444.95, "90th_percentile": 1444.95, "count": "1 through 10" } ] } ] }, { "description": "MAJOR BLADDER PROCEDURES - SOI : 4", "code_information": [ { "code": "4414", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 149559.97, "maximum": 158533.57, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 155801.25 } ] } ] }, { "description": "CYSTO W/ CATH URETER W/W/O IRR", "code_information": [ { "code": "52005", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5341.0, "discounted_cash": 419.0, "minimum": 331.407, "maximum": 4272.8, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 833.07, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 2356.16 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 1257.8 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 2621.89 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 2621.89 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1275.11, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 1190.1, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 901.07, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1402.62, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 892.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 892.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1402.62, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 850.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 850.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 850.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1275.11, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "OT IONTOPHORESIS 15 MIN", "code_information": [ { "code": "97033", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 24.0, "discounted_cash": 30.0, "minimum": 3.6, "maximum": 129.792, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.13, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 24.0 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 18.5 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 24.0 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 24.0 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.0, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 24.0, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 19.61, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 24.0, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 19.43, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.43, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 24.0, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 18.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 18.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 24.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 24.0, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "CATH ANGIOP 5X135X2X5.3", "code_information": [ { "code": "C1725", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 462.76, "10th_percentile": 256.45, "90th_percentile": 2515.23, "count": "21" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 270.69, "10th_percentile": 106.59, "90th_percentile": 1342.29, "count": "14" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 484.0, "10th_percentile": 143.56, "90th_percentile": 543.74, "count": "1 through 10" } ] } ] }, { "description": "7.3X16M CANNULATED SCRW", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "TRACHEOSTOMY W MV 96+ HOURS WO EXTENSIVE PROCEDURE - SOI : 3", "code_information": [ { "code": "0053", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 113323.87, "maximum": 120123.3, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 118052.98 } ] } ] }, { "description": "CORT SCREW 2323-16", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "REHABILITATION - SOI : 3", "code_information": [ { "code": "8603", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 17128.18, "maximum": 18155.87, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 17842.95 } ] } ] }, { "description": "CRYPTOCOCCAL AG LATEX(REF)", "code_information": [ { "code": "86403", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 141.67, "discounted_cash": 26.0, "minimum": 10.0398, "maximum": 154.024, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11.31, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.28 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 46.62 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 10.04 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.28 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 51.81 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 51.81 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17.31, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 16.16, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 12.23, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.04, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.12, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.26 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.79 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.12, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 20.55 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.28 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.5 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.04, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 11.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.81 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 11.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 16.68 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.31, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "VEIN LIGATION AND STRIPPING", "code_information": [ { "code": "263", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 10645.8754, "maximum": 33026.4, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 25458.8 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 29311.29 } ] } ] }, { "description": "SCREW LOCKING TITANIUM 3.5X16M", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "ACUTE ANXIETY & DELIRIUM STATES - SOI : 2", "code_information": [ { "code": "7562", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 6918.12, "maximum": 7333.21, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 7206.82 } ] } ] }, { "description": "URIC ACID BLD", "code_information": [ { "code": "84550", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 132.0, "discounted_cash": 25.0, "minimum": 3.9324, "maximum": 105.6, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4.43, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.38 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 18.26 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3.93 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.38 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 20.29 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 20.29 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 89.76, "10th_percentile": 73.92, "90th_percentile": 89.76, "count": "21" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.78, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 6.33, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 4.79, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 25.61, "10th_percentile": 23.76, "90th_percentile": 28.17, "count": "23" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.46, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.76 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.92 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 8.05 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.38 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.42 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.46, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "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": "fee schedule", "standard_charge_dollar": 6.19 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 25.08, "10th_percentile": 4.52, "90th_percentile": 25.08, "count": "31" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 4.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 23.76, "10th_percentile": 23.76, "90th_percentile": 28.17, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 7.39 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.78, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "DEXTROSE 50%-WATER SYRINGE", "drug_information": { "unit": 50.0, "type": "ML" }, "code_information": [ { "code": "00409751716", "type": "NDC" }, { "code": "J7042", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 29.97, "10th_percentile": 22.88, "90th_percentile": 30.61, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 29.97, "10th_percentile": 14.99, "90th_percentile": 29.97, "count": "1 through 10" } ] } ] }, { "description": "STENT PCLTXL ELUT 3.0X28", "code_information": [ { "code": "C1874", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 4258.8, "10th_percentile": 4258.8, "90th_percentile": 4420.0, "count": "1 through 10" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1456.46, "10th_percentile": 975.0, "90th_percentile": 4680.0, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1444.95, "10th_percentile": 1444.95, "90th_percentile": 1444.95, "count": "1 through 10" } ] } ] }, { "description": "SKIN GRAFT EXCEPT FOR SKIN ULCER OR CELLULITIS WITH CC", "code_information": [ { "code": "577", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 11793.4484, "maximum": 42431.0, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 42431.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 25412.26 } ] } ] }, { "description": "INGUINAL, FEMORAL & UMBILICAL HERNIA PROCEDURES - SOI : 1", "code_information": [ { "code": "2281", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 9773.61, "maximum": 10360.03, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 10181.48 } ] } ] }, { "description": "Total knee arthroplasty", "code_information": [ { "code": "27447", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8950.8, "discounted_cash": 1700.0, "minimum": 1342.62, "maximum": 17613.05, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5116.57, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 8950.8 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 8449.5 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 8950.8 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 8950.8 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7831.49, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 7309.39, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 5534.25, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 9721.25, "10th_percentile": 1697.33, "90th_percentile": 33399.74, "count": "1 through 10" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8614.63, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5482.04, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5482.04, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 24.6, "median_amount": 2788.3, "10th_percentile": 2788.3, "90th_percentile": 2788.3, "count": "1 through 10" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8614.63, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5220.99, "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": 19.0, "median_amount": 5700.0, "10th_percentile": 5700.0, "90th_percentile": 5700.0, "count": "1 through 10" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5220.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 5220.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 6075.0, "10th_percentile": 5700.0, "90th_percentile": 6075.0, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7831.49, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "CUSTOM CEMENT KNEE (MY KNEE)", "code_information": [ { "code": "C1776", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 4588.1, "10th_percentile": 1617.12, "90th_percentile": 11630.3, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 9120.0, "10th_percentile": 9120.0, "90th_percentile": 9120.0, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 8640.0, "10th_percentile": 8640.0, "90th_percentile": 9120.0, "count": "1 through 10" } ] } ] }, { "description": "CATH DILATION SLEEK OTW 4X100", "code_information": [ { "code": "C1725", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 462.76, "10th_percentile": 256.45, "90th_percentile": 2515.23, "count": "21" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 270.69, "10th_percentile": 106.59, "90th_percentile": 1342.29, "count": "14" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 484.0, "10th_percentile": 143.56, "90th_percentile": 543.74, "count": "1 through 10" } ] } ] }, { "description": "MAJOR CHEST TRAUMA WITH CC", "code_information": [ { "code": "184", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 4799.9492, "maximum": 22518.0, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 7761.37 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 10201.53 } ] } ] }, { "description": "CT ABD/PELVIS W/CONTRAST", "code_information": [ { "code": "74177", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7121.13, "discounted_cash": 1353.0, "minimum": 139.0326, "maximum": 5696.904, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 139.03, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 475.54 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 1542.67 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 332.21 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 475.54 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1714.51 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 1714.51 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 3987.83, "10th_percentile": 3987.83, "90th_percentile": 4842.37, "count": "37" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 212.81, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 198.62, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Gray Count Insurance MGMT Systems", "plan_name": "Gray County Insurance MGMT Systems", "methodology": "percent of total billed charges", "standard_charge_percentage": 50.0, "median_amount": 594.2, "10th_percentile": 594.2, "90th_percentile": 594.2, "count": "1 through 10" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 150.38, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 2136.34, "10th_percentile": 1942.12, "90th_percentile": 2136.35, "count": "1 through 10" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1353.01, "10th_percentile": 1281.8, "90th_percentile": 1519.65, "count": "62" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 234.09, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 148.96, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 504.07 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 665.57 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 148.96, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 600.2 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 475.54 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 627.9 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 234.09, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 141.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 461.69 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1353.01, "10th_percentile": 1353.01, "90th_percentile": 1353.01, "count": "54" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 141.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 141.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1353.01, "10th_percentile": 1353.01, "90th_percentile": 1519.65, "count": "16" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 468.16 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 212.81, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "MARLEX MESH LG PERFIX", "code_information": [ { "code": "C1781", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1862.28, "10th_percentile": 1862.28, "90th_percentile": 11852.02, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1206.78, "10th_percentile": 1206.78, "90th_percentile": 1206.78, "count": "1 through 10" } ] } ] }, { "description": "SCREW CORTEX SELF TPNG 2.7X40", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "THERAPEUTIC PHLEB", "code_information": [ { "code": "99195", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 345.0, "discounted_cash": 65.0, "minimum": 51.75, "maximum": 276.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 53.02, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 145.01 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 77.41 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 161.36 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 161.36 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 81.15, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 75.74, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 57.35, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 89.27, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 56.81, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 56.81, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 89.27, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 54.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 54.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 54.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 138.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 81.15, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "ANTEPARTUM WITHOUT O.R. PROCEDURE- SOI : 4", "code_information": [ { "code": "5664", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 12507.82, "maximum": 13258.29, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 13029.78 } ] } ] }, { "description": "FOOT PROCEDURES WITH MCC", "code_information": [ { "code": "503", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 12139.3366, "maximum": 54793.8, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 25121.8 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 26758.28 } ] } ] }, { "description": "CK MB", "code_information": [ { "code": "82553", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 272.25, "discounted_cash": 51.0, "minimum": 10.0485, "maximum": 217.8, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 75.0, "median_amount": 204.19, "10th_percentile": 204.19, "90th_percentile": 204.19, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11.32, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.3 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 46.66 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 10.05 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.3 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 51.86 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 51.86 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 152.46, "10th_percentile": 152.46, "90th_percentile": 185.13, "count": "1 through 10" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17.33, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 16.17, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 12.24, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 51.73, "10th_percentile": 49.01, "90th_percentile": 58.1, "count": "80" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.06, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.13, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.28 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.82 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.13, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 20.58 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.3 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.53 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.06, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 11.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.83 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 51.73, "10th_percentile": 51.73, "90th_percentile": 51.73, "count": "61" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 11.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 51.73, "10th_percentile": 49.01, "90th_percentile": 52.82, "count": "30" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 18.9 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.33, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "CATH ADMIRAL PTA BALLOON 4X130", "code_information": [ { "code": "C1725", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 462.76, "10th_percentile": 256.45, "90th_percentile": 2515.23, "count": "21" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 270.69, "10th_percentile": 106.59, "90th_percentile": 1342.29, "count": "14" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 484.0, "10th_percentile": 143.56, "90th_percentile": 543.74, "count": "1 through 10" } ] } ] }, { "description": "OTHER MULTIPLE SIGNIFICANT TRAUMA WITHOUT CCMCC", "code_information": [ { "code": "965", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 4215.7722, "maximum": 18765.0, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 6464.96 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 9016.57 } ] } ] }, { "description": "EXT DNA EXTRACTION OBI - 81479 - 800552", "code_information": [ { "code": "81479", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 28.5, "discounted_cash": 5.0, "minimum": 4.275, "maximum": 28.5, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 28.5 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 22.32 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 28.5 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 28.5 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 28.5 } ] } ] }, { "description": "STENT EVERFLEX EV3 7X150", "code_information": [ { "code": "C1876", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 3100.8, "10th_percentile": 1880.29, "90th_percentile": 7522.24, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 3482.69, "10th_percentile": 3482.69, "90th_percentile": 3482.69, "count": "1 through 10" } ] } ] }, { "description": "MANGANESE, PLASMA", "code_information": [ { "code": "83785", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 33.72, "discounted_cash": 6.0, "minimum": 5.058, "maximum": 33.72, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 26.12, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 33.72 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 33.72 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 23.19 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 33.72 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 33.72 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 33.72 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 33.72, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 33.72, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 28.25, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 33.72, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 27.98, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 33.72 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 33.72 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.98, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 33.72 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 33.72 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 33.72 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 33.72, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "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": "fee schedule", "standard_charge_dollar": 33.72 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 26.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 26.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 33.72 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 33.72, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "Insj subq impltbl dfb elctrd", "code_information": [ { "code": "33271", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5302.5, "discounted_cash": 1007.0, "minimum": 795.375, "maximum": 5302.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3297.97, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 5302.5 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 5302.5 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 5302.5 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 5302.5 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5047.92, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 4711.39, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 3567.2, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5302.5, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3533.54, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3533.54, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5302.5, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3365.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3365.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 3365.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5047.92, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "XR FEMUR 2 VIEWS-RT", "code_information": [ { "code": "73552", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 535.26, "discounted_cash": 101.0, "minimum": 34.6822, "maximum": 428.208, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 34.68, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 112.36 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 322.43 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 69.43 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 112.36 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 358.35 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 358.35 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 363.98, "10th_percentile": 330.89, "90th_percentile": 363.98, "count": "1 through 10" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 53.09, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 49.55, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 37.51, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 1348.22, "10th_percentile": 1348.22, "90th_percentile": 1348.22, "count": "1 through 10" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 114.22, "10th_percentile": 96.35, "90th_percentile": 114.22, "count": "1 through 10" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 58.39, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 37.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 119.1 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 157.26 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 37.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "QTC Medical Group", "plan_name": "QTC Medical Group", "methodology": "fee schedule", "standard_charge_dollar": 51.82 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 141.82 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 112.36 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 148.36 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 58.39, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 35.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 109.09 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 101.7, "10th_percentile": 101.7, "90th_percentile": 101.7, "count": "11" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 35.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 35.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 101.7, "10th_percentile": 96.35, "90th_percentile": 114.22, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 72.96 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 53.09, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "DUAL LEAD REPAIR", "code_information": [ { "code": "33220", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6401.0, "discounted_cash": 1216.0, "minimum": 960.15, "maximum": 5120.8, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1489.29, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 3968.73 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 2118.65 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 4416.33 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 4416.33 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2279.52, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 2127.55, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 1610.86, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2507.47, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1595.66, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1595.66, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2507.47, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1519.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1519.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 1519.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2279.52, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "EXC TR-EXT B9+MARG 1.1-2 CM - 11402 - 004147", "code_information": [ { "code": "11402", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3126.14, "discounted_cash": 755.0, "minimum": 81.74, "maximum": 3181.504, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 282.2, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 110.52 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 81.74 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 123.19 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 123.19 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 431.94, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 403.14, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 305.24, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 475.13, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 302.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 302.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 475.13, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 287.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 287.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 287.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 431.94, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "GENTAMICIN PEAK", "code_information": [ { "code": "80170", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 292.5, "discounted_cash": 44.0, "minimum": 14.2506, "maximum": 234.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 16.05, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.11 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 66.18 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 14.25 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.11 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 73.55 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 73.55 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.57, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 22.93, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 17.36, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 292.5, "10th_percentile": 292.5, "90th_percentile": 292.5, "count": "1 through 10" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 27.03, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 17.2, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.5 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 32.35 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.2, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 29.17 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.11 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.52 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 27.03, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 16.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.44 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 16.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 26.83 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 24.57, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "10-HYDROXYCARBAZEPINE", "code_information": [ { "code": "80183", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 89.1, "discounted_cash": 16.0, "minimum": 11.5275, "maximum": 71.28, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12.99, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.69 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 53.53 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 11.53 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.69 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 59.49 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 59.49 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.88, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 18.55, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 14.05, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.86, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 13.91, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.82 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26.17 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.91, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 23.6 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.69 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.68 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.86, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.15 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 21.71 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.88, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "PERIPHERAL & OTHER VASCULAR DISORDERS - SOI : 1", "code_information": [ { "code": "1971", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 7104.35, "maximum": 7530.61, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 7400.82 } ] } ] }, { "description": "CATH BALLOON ADMIRAL 5.0X120", "code_information": [ { "code": "C1725", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 462.76, "10th_percentile": 256.45, "90th_percentile": 2515.23, "count": "21" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 270.69, "10th_percentile": 106.59, "90th_percentile": 1342.29, "count": "14" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 484.0, "10th_percentile": 143.56, "90th_percentile": 543.74, "count": "1 through 10" } ] } ] }, { "description": "ANGINA PECTORIS & CORONARY ATHEROSCLEROSIS - SOI : 3", "code_information": [ { "code": "1983", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 9253.13, "maximum": 9808.32, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 9639.27 } ] } ] }, { "description": "TRI WIRE .035 X 150CM", "code_information": [ { "code": "C1769", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 228.66, "10th_percentile": 43.17, "90th_percentile": 1333.19, "count": "49" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 200.16, "10th_percentile": 45.57, "90th_percentile": 746.52, "count": "29" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 130.22, "10th_percentile": 39.18, "90th_percentile": 442.41, "count": "15" } ] } ] }, { "description": "SCREW,55MM", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "CATHETER BALLOON HSG 7FR", "code_information": [ { "code": "C1725", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 462.76, "10th_percentile": 256.45, "90th_percentile": 2515.23, "count": "21" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 270.69, "10th_percentile": 106.59, "90th_percentile": 1342.29, "count": "14" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 484.0, "10th_percentile": 143.56, "90th_percentile": 543.74, "count": "1 through 10" } ] } ] }, { "description": "TX/PRO/DX INJ SAME DRUG ADON(a - 96376 - 009045", "code_information": [ { "code": "96376", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 207.0, "discounted_cash": 49.0, "minimum": 20.6973, "maximum": 258.75, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 64.47 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 20.7 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 71.61 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 71.61 }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 93.15, "10th_percentile": 46.58, "90th_percentile": 279.45, "count": "147" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 49.16, "10th_percentile": 49.16, "90th_percentile": 147.49, "count": "24" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 55.22, "10th_percentile": 46.58, "90th_percentile": 98.33, "count": "31" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 207.0 } ] } ] }, { "description": "NEONATE BWT 1500-2499G W MAJOR PROCEDURE - SOI : 2", "code_information": [ { "code": "6092", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 28315.21, "maximum": 30014.12, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 29496.83 } ] } ] }, { "description": "SKIN GRAFT EXCEPT FOR SKIN ULCER OR CELLULITIS WITHOUT CCMCC", "code_information": [ { "code": "578", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 7530.5726, "maximum": 21798.7, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 21798.7 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 15400.56 } ] } ] }, { "description": "RUFINAMIDE", "code_information": [ { "code": "80210", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2801.6, "discounted_cash": 532.0, "minimum": 23.5857, "maximum": 2241.28, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 26.57, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 38.25 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 109.52 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 23.59 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 38.25 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 121.72 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 121.72 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 40.67, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 37.95, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 28.74, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 44.73, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 28.47, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 40.55 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 53.54 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.47, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 48.28 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 38.25 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 50.51 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 44.73, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 27.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 37.14 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 27.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 27.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 32.53 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.67, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "OTHER BACK & NECK DISORDERS, FRACTURES & INJURIES - SOI : 1", "code_information": [ { "code": "3471", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 8517.77, "maximum": 9028.84, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 8873.22 } ] } ] }, { "description": "MAJOR STOMACH, ESOPHAGEAL & DUODENAL PROCEDURES - SOI : 1", "code_information": [ { "code": "2201", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 18297.11, "maximum": 19394.94, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 19060.67 } ] } ] }, { "description": "OTHER DRUG ABUSE & DEPENDENCE - SOI : 1", "code_information": [ { "code": "7761", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 3830.56, "maximum": 4060.39, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 3990.41 } ] } ] }, { "description": "GUIDING CATH JL 5 6FR", "code_information": [ { "code": "C1887", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 115.24, "10th_percentile": 81.0, "90th_percentile": 503.66, "count": "23" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 156.51, "10th_percentile": 102.6, "90th_percentile": 572.45, "count": "11" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 129.36, "10th_percentile": 24.35, "90th_percentile": 512.12, "count": "1 through 10" } ] } ] }, { "description": "CORONARY INTRAVASCULAR LITHOTRIPSY WITHOUT INTRALUMINAL DEVICE", "code_information": [ { "code": "325", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 12150.0, "maximum": 30778.1048, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 27167.4 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 30778.1 } ] } ] }, { "description": "HIP BIOPOLAR", "code_information": [ { "code": "C1776", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 4588.1, "10th_percentile": 1617.12, "90th_percentile": 11630.3, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 9120.0, "10th_percentile": 9120.0, "90th_percentile": 9120.0, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 8640.0, "10th_percentile": 8640.0, "90th_percentile": 9120.0, "count": "1 through 10" } ] } ] }, { "description": "PLATE MINI STR 6 HOL", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "OTHER KIDNEY & URINARY TRACT DIAGNOSES, SIGNS & SYMPTOMS - SOI : 4", "code_information": [ { "code": "4684", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 62913.46, "maximum": 66688.26, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 65538.9 } ] } ] }, { "description": "OT EVAL LOW COMPLEX 30 MIN", "code_information": [ { "code": "97165", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 482.08, "discounted_cash": 91.0, "minimum": 72.312, "maximum": 385.664, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 75.0, "median_amount": 361.56, "10th_percentile": 361.56, "90th_percentile": 361.56, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 96.06, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 251.98 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 80.89 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 279.87 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 279.87 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 147.03, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 137.23, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 103.9, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 91.6, "10th_percentile": 91.6, "90th_percentile": 102.88, "count": "13" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 161.73, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 102.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 102.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 24.6, "median_amount": 119.68, "10th_percentile": 119.68, "90th_percentile": 119.68, "count": "1 through 10" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 161.73, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 98.02, "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": 19.0, "median_amount": 91.6, "10th_percentile": 91.6, "90th_percentile": 91.6, "count": "1 through 10" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 98.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 98.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 86.77, "10th_percentile": 86.77, "90th_percentile": 91.6, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 79.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 147.03, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "PRBC LR", "code_information": [ { "code": "P9016", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1328.53, "minimum": 180.32, "maximum": 1062.824, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 180.32, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 276.0, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 257.6, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 195.04, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 239.14, "10th_percentile": 239.14, "90th_percentile": 515.47, "count": "1 through 10" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 303.6, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 193.2, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 193.2, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 303.6, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 184.0, "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": 19.0, "median_amount": 252.42, "10th_percentile": 252.42, "90th_percentile": 504.84, "count": "1 through 10" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 184.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 184.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 239.14, "10th_percentile": 239.14, "90th_percentile": 239.14, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 341.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 276.0, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "SCREW BONE 6.5MMX8M CANCELLOUS", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "Lap enterolysis", "code_information": [ { "code": "44180", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5302.5, "discounted_cash": 1007.0, "minimum": 795.375, "maximum": 5302.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2409.3, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 5302.5 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 3431.93 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 5302.5 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 5302.5 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3687.71, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 3441.86, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 2605.98, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4056.48, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2581.39, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2581.39, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4056.48, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2458.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2458.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 2458.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3687.71, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "HOT PACK OT", "code_information": [ { "code": "97010", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 90.0, "discounted_cash": 17.0, "minimum": 5.6463, "maximum": 79.2, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 17.59 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5.65 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 19.53 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 19.53 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 79.0 } ] } ] }, { "description": "CALPROTECTIN, FECAL(REF)", "code_information": [ { "code": "83993", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 500.0, "discounted_cash": 104.0, "minimum": 17.0781, "maximum": 440.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.24, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.71 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 79.31 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 17.08 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.71 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 88.14 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 88.14 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 29.45, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 27.48, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 32.39, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 20.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 29.37 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 38.78 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 34.97 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.71 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 36.58 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 32.39, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "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": "fee schedule", "standard_charge_dollar": 26.9 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 19.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 19.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 32.14 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 29.45, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "Incision of thrombosed hemorrh", "code_information": [ { "code": "46083", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1291.31, "discounted_cash": 245.0, "minimum": 84.27, "maximum": 1033.048, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 99.57, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 113.94 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 84.27 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 127.0 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 127.0 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 152.4, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 142.24, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 107.7, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 167.64, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 106.68, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 106.68, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 167.64, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 101.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 101.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 101.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 152.4, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "BRUCELLA ANTIBODY, IgG", "code_information": [ { "code": "86622", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 65.15, "discounted_cash": 13.0, "minimum": 7.7691, "maximum": 58.64, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.75, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.6 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 36.08 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 7.77 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.6 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 40.1 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 40.1 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13.4, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 12.5, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 9.47, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.73, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 9.38, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.35 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.63 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.38, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 15.9 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.6 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.63 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.73, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 8.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.23 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 8.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 14.63 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 13.4, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "HIP REPLACEMENT WITH PRINCIPAL DIAGNOSIS OF HIP FRACTURE WITHOUT MCC", "code_information": [ { "code": "522", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 10109.2638, "maximum": 30024.0, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 19819.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 20302.39 } ] } ] }, { "description": "ANTI-HMGCR AB (RDL)", "code_information": [ { "code": "83516", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 450.0, "discounted_cash": 32.0, "minimum": 4.4625, "maximum": 436.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11.3, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.26 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 46.58 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 10.03 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.26 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 51.77 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 51.77 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 94.5, "10th_percentile": 94.5, "90th_percentile": 114.75, "count": "1 through 10" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17.3, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 16.14, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 12.22, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 30.38, "10th_percentile": 5.36, "90th_percentile": 96.03, "count": "1 through 10" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.02, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.24 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.76 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 20.53 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.26 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.47 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.02, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "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": "fee schedule", "standard_charge_dollar": 15.79 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 5.65, "10th_percentile": 5.65, "90th_percentile": 5.65, "count": "1 through 10" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 18.89 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.3, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "XR ELBOW 2+V-RT", "code_information": [ { "code": "73070", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 501.88, "discounted_cash": 95.0, "minimum": 34.6822, "maximum": 401.504, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 75.0, "median_amount": 376.41, "10th_percentile": 342.19, "90th_percentile": 376.41, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 34.68, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 112.36 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 322.43 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 69.43 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 112.36 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 358.35 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 358.35 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 310.25, "10th_percentile": 281.05, "90th_percentile": 341.28, "count": "1 through 10" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 53.09, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 49.55, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 37.51, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 150.56, "10th_percentile": 150.56, "90th_percentile": 150.56, "count": "1 through 10" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 95.36, "10th_percentile": 90.34, "90th_percentile": 107.1, "count": "12" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 58.39, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 37.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 119.1 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 157.26 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 37.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "QTC Medical Group", "plan_name": "QTC Medical Group", "methodology": "fee schedule", "standard_charge_dollar": 51.82 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange EPO/HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 27.55, "median_amount": 376.41, "10th_percentile": 376.41, "90th_percentile": 376.41, "count": "1 through 10" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 141.82 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 112.36 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 148.36 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 58.39, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 35.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 109.09 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 95.36, "10th_percentile": 95.36, "90th_percentile": 95.36, "count": "12" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 35.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 35.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 90.34, "10th_percentile": 90.34, "90th_percentile": 107.1, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 68.82 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 53.09, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "CANC SCREW 2333-45", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "PENIS, TESTES & SCROTAL PROCEDURES - SOI : 2", "code_information": [ { "code": "4832", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 15485.55, "maximum": 16414.69, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 16131.78 } ] } ] }, { "description": "STENT RESOLUTE ONYX 3.5X24MM", "code_information": [ { "code": "C1874", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 4258.8, "10th_percentile": 4258.8, "90th_percentile": 4420.0, "count": "1 through 10" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1456.46, "10th_percentile": 975.0, "90th_percentile": 4680.0, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1444.95, "10th_percentile": 1444.95, "90th_percentile": 1444.95, "count": "1 through 10" } ] } ] }, { "description": "TREAT HAND DISLOCATION LV3", "code_information": [ { "code": "26675", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1517.06, "discounted_cash": 288.0, "minimum": 227.559, "maximum": 1517.06, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 640.82, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 1517.06 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 962.33 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 1517.06 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 1517.06 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 980.85, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 915.46, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 693.13, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1078.94, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 686.6, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 686.6, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1078.94, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 653.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 653.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 653.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 980.85, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "KB STAIN (FETAL BLEED)", "code_information": [ { "code": "85460", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 199.0, "discounted_cash": 37.0, "minimum": 6.7251, "maximum": 159.2, "payers_information": [ { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.91 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.4 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.75, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 7.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.59 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 7.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 12.67 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11.6, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7.58, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.91 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 31.23 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 6.73 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.91 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 34.71 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 34.71 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11.6, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 10.82, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 8.19, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.75, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 8.12, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.56 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.27 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.12, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 13.77 } ] } ] }, { "description": "STENT ONYX FRONTIER 2.75X18MM", "code_information": [ { "code": "C1874", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 4258.8, "10th_percentile": 4258.8, "90th_percentile": 4420.0, "count": "1 through 10" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1456.46, "10th_percentile": 975.0, "90th_percentile": 4680.0, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1444.95, "10th_percentile": 1444.95, "90th_percentile": 1444.95, "count": "1 through 10" } ] } ] }, { "description": "SJOQRENS AB ANTISSA", "code_information": [ { "code": "86235", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 203.89, "discounted_cash": 38.0, "minimum": 3.5775, "maximum": 163.112, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17.57, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.3 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 72.44 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 15.6 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.3 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 80.51 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 80.51 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 224.63, "10th_percentile": 114.18, "90th_percentile": 411.41, "count": "1 through 10" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 26.9, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 25.1, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 19.01, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 89.78, "10th_percentile": 18.74, "90th_percentile": 147.23, "count": "1 through 10" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 29.58, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 18.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26.81 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 35.41 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 31.93 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.3 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 33.4 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 29.58, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.56 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 96.22, "10th_percentile": 18.74, "90th_percentile": 114.95, "count": "1 through 10" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 29.35 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 26.9, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "TX/PRO/DX INJ SAME DRUG ADON(a - 96376 - 060058", "code_information": [ { "code": "96376", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 258.75, "discounted_cash": 49.0, "minimum": 20.6973, "maximum": 258.75, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 64.47 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 20.7 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 71.61 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 71.61 }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 93.15, "10th_percentile": 46.58, "90th_percentile": 279.45, "count": "147" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 49.16, "10th_percentile": 49.16, "90th_percentile": 147.49, "count": "24" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 55.22, "10th_percentile": 46.58, "90th_percentile": 98.33, "count": "31" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 258.75 } ] } ] }, { "description": "CLEFT LIP & PALATE REPAIR - SOI : 3", "code_information": [ { "code": "0953", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 22778.04, "maximum": 24144.72, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 23728.59 } ] } ] }, { "description": "LIDOCAINE 1% VIAL", "drug_information": { "unit": 20.0, "type": "ML" }, "code_information": [ { "code": "00409427601", "type": "NDC" }, { "code": "J2003", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 22.4, "10th_percentile": 22.4, "90th_percentile": 27.2, "count": "28" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 7.6, "10th_percentile": 3.41, "90th_percentile": 17.07, "count": "43" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 7.6, "10th_percentile": 3.04, "90th_percentile": 7.6, "count": "55" } ] } ] }, { "description": "AUTOLOGOUS BONE MARROW TRANSPLANT OR T-CELL IMMUNOTHERAPY- SOI : 3", "code_information": [ { "code": "0083", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 142485.22, "maximum": 151034.34, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 148431.27 } ] } ] }, { "description": "Colonoscopy wlesion removal", "code_information": [ { "code": "45384", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7500.0, "discounted_cash": 1425.0, "minimum": 476.8876, "maximum": 6000.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 476.89, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 1335.61 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 713.0 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 1486.25 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 1486.25 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 729.93, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 681.27, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 515.82, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 802.92, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 510.95, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 510.95, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 802.92, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 486.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 486.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 486.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 729.93, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "ENDOBUTTON 60MM", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "SCREW COMPRESSION SHORT 2.4X22", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "ALCOHOL ABUSE & DEPENDENCE - SOI : 3", "code_information": [ { "code": "7753", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 11558.53, "maximum": 12252.05, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 12040.88 } ] } ] }, { "description": "MUSCULOSKELETAL & OTHER PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA - SOI : 1", "code_information": [ { "code": "9121", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 26815.84, "maximum": 28424.79, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 27934.89 } ] } ] }, { "description": "ACUTE LEUKEMIA - SOI : 2", "code_information": [ { "code": "6902", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 51129.54, "maximum": 54197.31, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 53263.22 } ] } ] }, { "description": "STENT XIENCE ALPINE 4.0X15MM", "code_information": [ { "code": "C1874", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 4258.8, "10th_percentile": 4258.8, "90th_percentile": 4420.0, "count": "1 through 10" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1456.46, "10th_percentile": 975.0, "90th_percentile": 4680.0, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1444.95, "10th_percentile": 1444.95, "90th_percentile": 1444.95, "count": "1 through 10" } ] } ] }, { "description": "THIN PREP,PAP SMEAR", "code_information": [ { "code": "88141", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 85.0, "discounted_cash": 16.0, "minimum": 12.75, "maximum": 85.0, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 85.0 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 28.22 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 85.0 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 85.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 38.26 } ] } ] }, { "description": "KIDNEY TRANSPLANT WITH HEMODIALYSIS WITH MCC", "code_information": [ { "code": "650", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 22628.2, "maximum": 47287.8, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 22628.2 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 45072.32 } ] } ] }, { "description": "COCR HUM SHOULDER 44X16", "code_information": [ { "code": "C1776", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 4588.1, "10th_percentile": 1617.12, "90th_percentile": 11630.3, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 9120.0, "10th_percentile": 9120.0, "90th_percentile": 9120.0, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 8640.0, "10th_percentile": 8640.0, "90th_percentile": 9120.0, "count": "1 through 10" } ] } ] }, { "description": "APPENDECTOMY WITHOUT COMPLEX PRINCIPAL DIAGNOSIS - SOI : 1", "code_information": [ { "code": "2341", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 9352.45, "maximum": 9913.6, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 9742.74 } ] } ] }, { "description": "OTHER INFECTIOUS & PARASITIC DISEASES - SOI : 3", "code_information": [ { "code": "7243", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 15323.2, "maximum": 16242.59, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 15962.65 } ] } ] }, { "description": "CATHETER GUIDE 3.5 EBU 5FR", "code_information": [ { "code": "C1725", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 462.76, "10th_percentile": 256.45, "90th_percentile": 2515.23, "count": "21" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 270.69, "10th_percentile": 106.59, "90th_percentile": 1342.29, "count": "14" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 484.0, "10th_percentile": 143.56, "90th_percentile": 543.74, "count": "1 through 10" } ] } ] }, { "description": "STENT XIENCE SIERRA 2.5X23MM", "code_information": [ { "code": "C1874", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 4258.8, "10th_percentile": 4258.8, "90th_percentile": 4420.0, "count": "1 through 10" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1456.46, "10th_percentile": 975.0, "90th_percentile": 4680.0, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1444.95, "10th_percentile": 1444.95, "90th_percentile": 1444.95, "count": "1 through 10" } ] } ] }, { "description": "CATHETER 6FR JR4 LONG", "code_information": [ { "code": "C1725", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 462.76, "10th_percentile": 256.45, "90th_percentile": 2515.23, "count": "21" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 270.69, "10th_percentile": 106.59, "90th_percentile": 1342.29, "count": "14" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 484.0, "10th_percentile": 143.56, "90th_percentile": 543.74, "count": "1 through 10" } ] } ] }, { "description": "VAGINAL DELIVERY W COMPLICATING PROCEDURES EXC STERILIZATION &OR D&C - SOI : 2", "code_information": [ { "code": "5422", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 5168.54, "maximum": 7551.34, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 7551.34 } ] } ] }, { "description": "HIV W MAJOR HIV RELATED CONDITION - SOI : 1", "code_information": [ { "code": "8921", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 7990.6, "maximum": 8470.04, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 8324.06 } ] } ] }, { "description": "PROTEIN, BODY FLUID - 84157 - 800639", "code_information": [ { "code": "84157", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 22.0, "discounted_cash": 4.0, "minimum": 3.3, "maximum": 125.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3.92, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.64 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 16.16 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3.48 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.64 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 17.96 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 17.96 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.0, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 5.6, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 4.24, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.6, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 4.2, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.98 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.9 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.2, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 7.12 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.64 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.45 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.6, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 4.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.48 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 4.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 6.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.0, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "CANC SCREW 2322-35", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "SCRW UNI GLENOID PERIPHERAL LO", "code_information": [ { "code": "c1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "CATH BLNDIL .035IN 3MM 135CM", "code_information": [ { "code": "C1725", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 462.76, "10th_percentile": 256.45, "90th_percentile": 2515.23, "count": "21" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 270.69, "10th_percentile": 106.59, "90th_percentile": 1342.29, "count": "14" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 484.0, "10th_percentile": 143.56, "90th_percentile": 543.74, "count": "1 through 10" } ] } ] }, { "description": "GUIDWIRE MOVEABLE CORE", "code_information": [ { "code": "C1769", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 228.66, "10th_percentile": 43.17, "90th_percentile": 1333.19, "count": "49" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 200.16, "10th_percentile": 45.57, "90th_percentile": 746.52, "count": "29" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 130.22, "10th_percentile": 39.18, "90th_percentile": 442.41, "count": "15" } ] } ] }, { "description": "OSTEOMYELITIS WITH CC", "code_information": [ { "code": "540", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 5981.6954, "maximum": 31525.2, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 7738.28 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 12427.63 } ] } ] }, { "description": "STENT MULTI LINK VISION 3X28MM", "code_information": [ { "code": "C1876", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 3100.8, "10th_percentile": 1880.29, "90th_percentile": 7522.24, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 3482.69, "10th_percentile": 3482.69, "90th_percentile": 3482.69, "count": "1 through 10" } ] } ] }, { "description": "GUIDEWIRE THREADED 1.25X150MM", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 168.56, "10th_percentile": 168.56, "90th_percentile": 168.56, "count": "1 through 10" } ] } ] }, { "description": "DENTAL AND ORAL DISEASES WITH MCC", "code_information": [ { "code": "157", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 7261.3432, "maximum": 33026.4, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 13821.8 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 16458.96 } ] } ] }, { "description": "ER ROOM - LEVEL 1", "code_information": [ { "code": "99281", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 417.32, "discounted_cash": 79.0, "minimum": 15.17, "maximum": 335.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 33.6, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 194.94 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 63.35 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 216.52 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 216.52 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 237.08, "10th_percentile": 233.7, "90th_percentile": 283.78, "count": "1 through 10" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 51.44, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 48.01, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 36.35, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 104.6, "10th_percentile": 104.6, "90th_percentile": 125.2, "count": "1 through 10" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 74.4, "10th_percentile": 74.4, "90th_percentile": 89.06, "count": "22" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 225.14, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 36.0, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.5 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.0, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 13.53, "median_amount": 58.75, "10th_percentile": 49.09, "90th_percentile": 124.85, "count": "35" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 56.58, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 34.29, "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": 19.0, "median_amount": 79.29, "10th_percentile": 79.29, "90th_percentile": 79.29, "count": "1 through 10" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 34.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 34.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 89.06, "10th_percentile": 74.4, "90th_percentile": 89.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 335.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 51.44, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "SCREW 30MM", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "FEMORAL 53MM A/P 75MM M/L MOLD", "code_information": [ { "code": "C1776", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 4588.1, "10th_percentile": 1617.12, "90th_percentile": 11630.3, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 9120.0, "10th_percentile": 9120.0, "90th_percentile": 9120.0, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 8640.0, "10th_percentile": 8640.0, "90th_percentile": 9120.0, "count": "1 through 10" } ] } ] }, { "description": "VERSATEL ONE 2X3", "code_information": [ { "code": "A6206", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 8.02, "10th_percentile": 8.02, "90th_percentile": 16.04, "count": "1 through 10" } ] } ] }, { "description": "SCREW CORTICLE 4.5X32M", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "SHUNTOGRAM", "code_information": [ { "code": "75809", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 690.0, "discounted_cash": 131.0, "minimum": 41.6598, "maximum": 552.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 41.66, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 135.95 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 452.8 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 97.51 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 135.95 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 503.24 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 503.24 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 63.77, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 59.51, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 45.06, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 70.14, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 44.64, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 144.11 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 190.28 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 44.64, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 171.59 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 135.95 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 179.51 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 70.14, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 42.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 131.99 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 42.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 42.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 109.07 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 63.77, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "GUIDEWIRE .035 ANGLED", "code_information": [ { "code": "C1769", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 228.66, "10th_percentile": 43.17, "90th_percentile": 1333.19, "count": "49" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 200.16, "10th_percentile": 45.57, "90th_percentile": 746.52, "count": "29" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 130.22, "10th_percentile": 39.18, "90th_percentile": 442.41, "count": "15" } ] } ] }, { "description": "CTA RT UPPER EXTREMITY", "code_information": [ { "code": "73206", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3390.0, "discounted_cash": 515.0, "minimum": 69.8936, "maximum": 2712.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 69.89, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 227.2 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 736.17 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 158.53 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 227.2 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 818.17 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 818.17 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 106.98, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 99.85, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 75.6, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 117.68, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 74.89, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 240.83 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 317.99 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 74.89, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 286.75 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 227.2 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 299.99 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 117.68, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 71.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 220.58 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 71.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 71.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 350.35 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 106.98, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "AEROBIC ORG ID", "code_information": [ { "code": "87077", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 124.92, "discounted_cash": 23.0, "minimum": 7.0296, "maximum": 99.936, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 75.0, "median_amount": 93.69, "10th_percentile": 93.69, "90th_percentile": 93.69, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7.92, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.4 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 32.64 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 7.03 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.4 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 36.28 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 36.28 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 69.96, "10th_percentile": 69.96, "90th_percentile": 84.95, "count": "18" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12.12, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 11.31, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 8.56, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 150.35, "10th_percentile": 136.68, "90th_percentile": 150.35, "count": "16" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 24.23, "10th_percentile": 8.08, "90th_percentile": 48.47, "count": "130" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 13.33, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 8.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.09 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.96 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 14.39 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.4 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.06 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.33, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 8.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.07 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 8.08, "10th_percentile": 8.08, "90th_percentile": 23.73, "count": "139" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 8.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 24.23, "10th_percentile": 22.49, "90th_percentile": 40.7, "count": "42" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 13.24 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.12, "additional_payer_notes": "150.00% 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", "minimum": 26263.9514, "maximum": 83316.6, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 42197.6 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 56225.84 } ] } ] }, { "description": "VERTEBRAL AND INTERVERTEBRAL SPINAL PROCEDURES INCLUDING DISC PROCEDURES- SOI : 4", "code_information": [ { "code": "3104", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 65546.43, "maximum": 69479.22, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 68281.75 } ] } ] }, { "description": "FEMORAL HEAD CERAMIC SZ S 28MM", "code_information": [ { "code": "C1776", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 4588.1, "10th_percentile": 1617.12, "90th_percentile": 11630.3, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 9120.0, "10th_percentile": 9120.0, "90th_percentile": 9120.0, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 8640.0, "10th_percentile": 8640.0, "90th_percentile": 9120.0, "count": "1 through 10" } ] } ] }, { "description": "SCREW 4.0X60 SHORT THREAD", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "XR CHOLECYST ORAL", "code_information": [ { "code": "74290", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 547.0, "discounted_cash": 103.0, "minimum": 69.8936, "maximum": 547.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 69.89, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 227.2 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 547.0 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 158.53 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 227.2 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 547.0 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 547.0 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 106.98, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 99.85, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 75.6, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 117.68, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 74.89, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 240.83 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 317.99 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 74.89, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 286.75 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 227.2 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 299.99 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 117.68, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 71.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 220.58 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 71.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 71.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 122.21 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 106.98, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "MAJOR SHOULDER OR ELBOW JOINT PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "508", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 6529.852, "maximum": 19515.6, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 12250.9 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 14518.55 } ] } ] }, { "description": "CORTICAL SCREW (IOI)", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "MONORAIL STENT 8MMX 2.5", "code_information": [ { "code": "C1876", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 3100.8, "10th_percentile": 1880.29, "90th_percentile": 7522.24, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 3482.69, "10th_percentile": 3482.69, "90th_percentile": 3482.69, "count": "1 through 10" } ] } ] }, { "description": "CATH EUPHORA RX 2.0X30MM", "code_information": [ { "code": "C1725", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 462.76, "10th_percentile": 256.45, "90th_percentile": 2515.23, "count": "21" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 270.69, "10th_percentile": 106.59, "90th_percentile": 1342.29, "count": "14" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 484.0, "10th_percentile": 143.56, "90th_percentile": 543.74, "count": "1 through 10" } ] } ] }, { "description": "Organism Identification, Mold", "code_information": [ { "code": "87107", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 255.0, "discounted_cash": 48.0, "minimum": 8.9784, "maximum": 204.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.11, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.56 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 41.69 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 8.98 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.56 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 46.34 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 46.34 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.48, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 14.45, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 10.94, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.03, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 10.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.44 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.38 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 18.38 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.56 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.23 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.03, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "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": "fee schedule", "standard_charge_dollar": 14.14 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 10.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 10.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 16.91 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15.48, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "HYPERTENSION - SOI : 4", "code_information": [ { "code": "1994", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 20520.39, "maximum": 21751.61, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 21376.72 } ] } ] }, { "description": "PACEMAKER DR DISCOVERY", "code_information": [ { "code": "C1785", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 6147.84, "10th_percentile": 6147.84, "90th_percentile": 6147.84, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 6147.84, "10th_percentile": 6147.84, "90th_percentile": 6147.84, "count": "1 through 10" } ] } ] }, { "description": "COMPRESSION SCRW LNG 2.4X20", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "BCR-ABL1 KINASE DOMAIN MUT ANA", "code_information": [ { "code": "81170", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2239.9, "discounted_cash": 425.0, "minimum": 261.0, "maximum": 1791.92, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 294.0, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 423.33 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 1212.0 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 261.0 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 423.33 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1347.0 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 1347.0 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 450.0, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 420.0, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 318.0, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 495.0, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 315.0, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 448.73 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 592.5 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 315.0, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 534.3 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 423.33 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 558.96 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 495.0, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 300.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 411.0 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 300.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 300.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 395.41 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 450.0, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "NON-BACTERIAL INFECTION OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS WITH MCC", "code_information": [ { "code": "097", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 22530.7, "maximum": 65302.2, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 22530.7 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 34626.33 } ] } ] }, { "description": "BRAIN CONTUSIONLACERATION & COMPLICATED SKULL FX, COMA < 1 HR OR NO COMA - SOI : 3", "code_information": [ { "code": "0563", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 19717.22, "maximum": 20900.25, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 20540.04 } ] } ] }, { "description": "OTHER O.R. PROCEDURES FOR LYMPHATICHEMATOPOIETICOTHER NEOPLASMS - SOI : 2", "code_information": [ { "code": "6812", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 25639.26, "maximum": 27177.62, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 26709.21 } ] } ] }, { "description": "LUPUS ANTICOAGULAT PANEL", "code_information": [ { "code": "85705", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 309.19, "discounted_cash": 58.0, "minimum": 8.3781, "maximum": 247.352, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.44, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.6 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 38.91 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 8.38 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.6 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 43.24 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 43.24 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14.45, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 13.48, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 10.21, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 65.98, "10th_percentile": 65.98, "90th_percentile": 65.98, "count": "1 through 10" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15.89, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 10.11, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.41 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.03 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.11, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 17.16 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.6 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.95 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.89, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 9.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.2 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 9.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 9.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 15.76 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.45, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "OTHER NERVOUS SYSTEM & RELATED PROCEDURES - SOI : 2", "code_information": [ { "code": "0262", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 27007.8, "maximum": 28628.26, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 28134.86 } ] } ] }, { "description": "OTHER EAR, NOSE, MOUTH AND THROAT O.R. PROCEDURES WITH CC", "code_information": [ { "code": "144", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 8083.809, "maximum": 21016.8, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 8312.95 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 16613.31 } ] } ] }, { "description": "HEADLESS COMPRESSION SCRW 18MM", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "PSYTX PT&/FAM W/E&M 45 MN(900)", "code_information": [ { "code": "90836", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 718.75, "discounted_cash": 136.0, "minimum": 99.0, "maximum": 575.0, "payers_information": [ { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 118.0 } ] } ] }, { "description": "ORTHO CARBON BAR 8X200MM", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "UNLISTED MUSC PROC, HEAD", "code_information": [ { "code": "21499", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 808.06, "discounted_cash": 153.0, "minimum": 94.3936, "maximum": 646.448, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 94.39, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 270.84 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 144.58 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 301.39 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 301.39 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 144.48, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 134.85, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 102.1, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 158.93, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 101.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 101.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 158.93, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 96.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 96.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 96.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 144.48, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "Osteochondral knee allograft", "code_information": [ { "code": "27415", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 14140.0, "discounted_cash": 2686.0, "minimum": 2121.0, "maximum": 14140.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5116.57, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 14140.0 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 8449.5 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 14140.0 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 14140.0 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7831.49, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 7309.39, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 5534.25, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8614.63, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5482.04, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5482.04, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8614.63, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5220.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5220.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 5220.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7831.49, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "SPINAL DISORDERS & INJURIES - SOI : 3", "code_information": [ { "code": "0403", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 36331.6, "maximum": 38511.49, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 37847.75 } ] } ] }, { "description": "TENDON, MUSCLE & OTHER SOFT TISSUE PROCEDURES - SOI : 1", "code_information": [ { "code": "3171", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 14796.03, "maximum": 15683.79, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 15413.48 } ] } ] }, { "description": "C-TELOPEPTIDE SERUM", "code_information": [ { "code": "82523", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 283.05, "discounted_cash": 53.0, "minimum": 16.2516, "maximum": 226.44, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.31, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26.36 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 75.47 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 16.25 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26.36 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 83.87 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 83.87 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 28.02, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 26.15, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 19.8, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 30.82, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 19.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.94 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 36.89 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 33.27 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26.36 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 34.8 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 30.82, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 18.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.59 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 18.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 30.6 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 28.02, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "SCREW BN SLF TAP SS T25 5X65 M", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "XR TIBIA/FIBULA 2 V-LT", "code_information": [ { "code": "73590", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 517.72, "discounted_cash": 98.0, "minimum": 34.6822, "maximum": 414.176, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 34.68, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 112.36 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 322.43 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 69.43 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 112.36 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 358.35 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 358.35 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 320.04, "10th_percentile": 289.92, "90th_percentile": 352.05, "count": "1 through 10" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 53.09, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 49.55, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 37.51, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 155.32, "10th_percentile": 155.32, "90th_percentile": 291.0, "count": "1 through 10" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 110.48, "10th_percentile": 75.07, "90th_percentile": 110.48, "count": "1 through 10" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 58.39, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 37.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 119.1 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 157.26 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 37.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "QTC Medical Group", "plan_name": "QTC Medical Group", "methodology": "fee schedule", "standard_charge_dollar": 51.82 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 141.82 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 112.36 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 148.36 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 58.39, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 35.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 109.09 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 98.37, "10th_percentile": 98.37, "90th_percentile": 98.37, "count": "1 through 10" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 35.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 35.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 93.19, "10th_percentile": 93.19, "90th_percentile": 100.44, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 68.82 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 53.09, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "CATH ADMIRAL BALLOON 5.0X130", "code_information": [ { "code": "C1725", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 462.76, "10th_percentile": 256.45, "90th_percentile": 2515.23, "count": "21" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 270.69, "10th_percentile": 106.59, "90th_percentile": 1342.29, "count": "14" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 484.0, "10th_percentile": 143.56, "90th_percentile": 543.74, "count": "1 through 10" } ] } ] }, { "description": "STENT ONYX FRONTIER 2.0X18MM", "code_information": [ { "code": "C1874", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 4258.8, "10th_percentile": 4258.8, "90th_percentile": 4420.0, "count": "1 through 10" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1456.46, "10th_percentile": 975.0, "90th_percentile": 4680.0, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1444.95, "10th_percentile": 1444.95, "90th_percentile": 1444.95, "count": "1 through 10" } ] } ] }, { "description": "SCREW 5.0 SELF DRILLING 60X150", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "CATH QUANTUM 20MM X 5.0M", "code_information": [ { "code": "C1725", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 462.76, "10th_percentile": 256.45, "90th_percentile": 2515.23, "count": "21" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 270.69, "10th_percentile": 106.59, "90th_percentile": 1342.29, "count": "14" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 484.0, "10th_percentile": 143.56, "90th_percentile": 543.74, "count": "1 through 10" } ] } ] }, { "description": "AMMONIA", "code_information": [ { "code": "82140", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 235.13, "discounted_cash": 44.0, "minimum": 12.6759, "maximum": 188.104, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14.28, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.56 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 58.86 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.68 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.56 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 65.42 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 65.42 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 159.89, "10th_percentile": 159.89, "90th_percentile": 159.89, "count": "1 through 10" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 21.86, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 20.4, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 15.44, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 44.67, "10th_percentile": 14.57, "90th_percentile": 50.18, "count": "20" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 24.04, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 15.3, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.79 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28.77 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.3, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 25.95 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.56 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.15 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 24.04, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.96 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 44.67, "10th_percentile": 14.57, "90th_percentile": 44.67, "count": "20" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 45.61, "10th_percentile": 42.32, "90th_percentile": 50.18, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 23.86 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.86, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "COMPLEMENT TOT CH50", "code_information": [ { "code": "86162", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 273.75, "discounted_cash": 52.0, "minimum": 17.6784, "maximum": 219.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.91, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28.68 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 82.09 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 17.68 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28.68 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 91.24 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 91.24 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 30.48, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 28.45, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 21.54, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 33.53, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 21.34, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.4 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 40.13 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.34, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 36.19 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28.68 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 37.86 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 33.53, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 20.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.84 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 20.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 20.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 33.26 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 30.48, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "SCREW LO-PRO LOCK TI 4.5X18", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "OTHER KIDNEY, URINARY TRACT & RELATED PROCEDURES - SOI : 4", "code_information": [ { "code": "4474", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 118429.38, "maximum": 125535.14, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 123371.55 } ] } ] }, { "description": "MESH VENTRALIGHT 10CMX15CM 4X6", "code_information": [ { "code": "C1781", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1862.28, "10th_percentile": 1862.28, "90th_percentile": 11852.02, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1206.78, "10th_percentile": 1206.78, "90th_percentile": 1206.78, "count": "1 through 10" } ] } ] }, { "description": "VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITHOUT CCMCC", "code_information": [ { "code": "807", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 3591.64, "maximum": 15012.0, "payers_information": [ { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 6500.0, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 3591.64 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 3898.0 } ] } ] }, { "description": "PELVIC EVISCERATION, RADICAL HYSTERECTOMY & OTHER RADICAL GYN PROCS - SOI : 3", "code_information": [ { "code": "5103", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 35629.66, "maximum": 37767.44, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 37116.52 } ] } ] }, { "description": "MED NUT THERAPY GRP 30M", "code_information": [ { "code": "97804", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 58.0, "discounted_cash": 12.0, "minimum": 8.7, "maximum": 68.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11.9, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 43.96 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 14.11 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 48.82 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 48.82 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.21, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 17.0, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 20.03, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.75, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.75, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.03, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 12.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 58.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.21, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "PERIPROSTHETIC SCRW 5.0", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "DILATION & CURETTAGE FOR NON-OBSTETRIC DIAGNOSES - SOI : 1", "code_information": [ { "code": "5171", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 7700.28, "maximum": 8162.29, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 8021.62 } ] } ] }, { "description": "CULTURE BLOOD", "code_information": [ { "code": "87040", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 326.55, "discounted_cash": 62.0, "minimum": 7.3125, "maximum": 261.24, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.11, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.56 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 41.69 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 8.98 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.56 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 46.34 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 46.34 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 183.5, "10th_percentile": 182.87, "90th_percentile": 222.05, "count": "18" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.48, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 14.45, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Gray Count Insurance MGMT Systems", "plan_name": "Gray County Insurance MGMT Systems", "methodology": "percent of total billed charges", "standard_charge_percentage": 50.0, "median_amount": 18.1, "10th_percentile": 18.1, "90th_percentile": 18.1, "count": "1 through 10" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 10.94, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 62.04, "10th_percentile": 58.78, "90th_percentile": 69.69, "count": "101" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.03, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 10.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.44 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.38 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 18.38 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.56 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.23 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.03, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "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": "fee schedule", "standard_charge_dollar": 14.14 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 62.04, "10th_percentile": 62.04, "90th_percentile": 124.09, "count": "66" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 10.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 10.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 62.04, "10th_percentile": 58.78, "90th_percentile": 69.69, "count": "31" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 16.91 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15.48, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "CANC SCREW 2333-90", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "STENT RESOLUTE RX 3.0 X 12MM", "code_information": [ { "code": "C1874", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 4258.8, "10th_percentile": 4258.8, "90th_percentile": 4420.0, "count": "1 through 10" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1456.46, "10th_percentile": 975.0, "90th_percentile": 4680.0, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1444.95, "10th_percentile": 1444.95, "90th_percentile": 1444.95, "count": "1 through 10" } ] } ] }, { "description": "CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITH CC", "code_information": [ { "code": "217", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 23400.0, "maximum": 63037.4011, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 44913.5 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 63037.4 } ] } ] }, { "description": "PERMANENT CARDIAC PACEMAKER IMPLANT WITH CC", "code_information": [ { "code": "243", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 11695.5468, "maximum": 23477.202, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 19471.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 20428.94 } ] } ] }, { "description": "PLATE DISTAL RADIUS LEFT 2.4MM", "code_information": [ { "code": "C1713", "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": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" } ] } ] }, { "description": "STENT 2.75MM X 30MM RSLT ONYX", "code_information": [ { "code": "C1874", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 4258.8, "10th_percentile": 4258.8, "90th_percentile": 4420.0, "count": "1 through 10" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1456.46, "10th_percentile": 975.0, "90th_percentile": 4680.0, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1444.95, "10th_percentile": 1444.95, "90th_percentile": 1444.95, "count": "1 through 10" } ] } ] }, { "description": "STENT INTEGRITY 3.0X12MM", "code_information": [ { "code": "C1876", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 3100.8, "10th_percentile": 1880.29, "90th_percentile": 7522.24, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 3482.69, "10th_percentile": 3482.69, "90th_percentile": 3482.69, "count": "1 through 10" } ] } ] }, { "description": "HIP & FEMUR FRACTURE REPAIR - SOI : 4", "code_information": [ { "code": "3084", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 57252.13, "maximum": 60687.26, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 59641.32 } ] } ] }, { "description": "STREP PNEUMO AGN/PRTCLE AGG AN", "code_information": [ { "code": "86403", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 192.53, "discounted_cash": 26.0, "minimum": 10.0398, "maximum": 154.024, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11.31, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.28 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 46.62 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 10.04 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.28 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 51.81 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 51.81 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17.31, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 16.16, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 12.23, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.04, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.12, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.26 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.79 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.12, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 20.55 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.28 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.5 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.04, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 11.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.81 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 11.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 16.68 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.31, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "EKG-ROUTINE", "code_information": [ { "code": "93005", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 437.25, "discounted_cash": 83.0, "minimum": 23.5004, "maximum": 349.8, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 75.0, "median_amount": 298.13, "10th_percentile": 298.13, "90th_percentile": 327.94, "count": "12" }, { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 23.5, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 149.08 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 47.86 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 165.58 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 165.58 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 270.3, "10th_percentile": 244.86, "90th_percentile": 297.33, "count": "69" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 35.97, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 33.57, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 25.42, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 131.17, "10th_percentile": 119.25, "90th_percentile": 23914.39, "count": "1 through 10" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 83.08, "10th_percentile": 78.71, "90th_percentile": 93.31, "count": "441" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 39.57, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 25.18, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.18, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange EPO/HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 27.55, "median_amount": 6.5, "10th_percentile": 6.5, "90th_percentile": 6.5, "count": "1 through 10" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 24.6, "median_amount": 6.82, "10th_percentile": 5.33, "90th_percentile": 13.82, "count": "73" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 24.6, "median_amount": 6.91, "10th_percentile": 6.91, "90th_percentile": 13.82, "count": "1 through 10" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 39.57, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 23.98, "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": 24.6, "median_amount": 87.45, "10th_percentile": 79.5, "90th_percentile": 90.07, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 83.08, "10th_percentile": 83.08, "90th_percentile": 83.08, "count": "288" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 23.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 23.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 83.08, "10th_percentile": 78.71, "90th_percentile": 93.31, "count": "133" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 269.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 35.97, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "SCRWSTARDRIVE 2.4X18MM", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "OTHER PROCEDURES OF BLOOD & BLOOD-FORMING ORGANS - SOI : 2", "code_information": [ { "code": "6512", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 18550.19, "maximum": 19663.2, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 19324.31 } ] } ] }, { "description": "AMPUTATION OF LOWER LIMB EXCEPT TOES - SOI : 3", "code_information": [ { "code": "3053", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 29034.34, "maximum": 30776.4, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 30245.97 } ] } ] }, { "description": "STENT RESOLUTE ONYX 3.0X15MM", "code_information": [ { "code": "C1874", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 4258.8, "10th_percentile": 4258.8, "90th_percentile": 4420.0, "count": "1 through 10" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1456.46, "10th_percentile": 975.0, "90th_percentile": 4680.0, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1444.95, "10th_percentile": 1444.95, "90th_percentile": 1444.95, "count": "1 through 10" } ] } ] }, { "description": "CATHETER GUIDING JL 3.5", "code_information": [ { "code": "C1887", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 115.24, "10th_percentile": 81.0, "90th_percentile": 503.66, "count": "23" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 156.51, "10th_percentile": 102.6, "90th_percentile": 572.45, "count": "11" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 129.36, "10th_percentile": 24.35, "90th_percentile": 512.12, "count": "1 through 10" } ] } ] }, { "description": "OTHER PNEUMONIA - SOI : 3", "code_information": [ { "code": "1393", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 11578.59, "maximum": 12273.31, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 12061.78 } ] } ] }, { "description": "Thyroid Binding Globulin (TBG)", "code_information": [ { "code": "84442", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 46.85, "discounted_cash": 8.0, "minimum": 7.0275, "maximum": 46.85, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14.48, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.86 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 46.85 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.86 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.86 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 46.85 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 46.85 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.17, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 20.69, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 15.67, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 24.39, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 15.52, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.11 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 29.19 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.52, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 26.33 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.86 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.54 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 24.39, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.25 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 24.2 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 22.17, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "DRILL BIT 3FLUTED2.7X125", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 168.56, "10th_percentile": 168.56, "90th_percentile": 168.56, "count": "1 through 10" } ] } ] }, { "description": "ALPHA-1 ANTITRYPSIN PHENOTYPE", "code_information": [ { "code": "82104", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 72.6, "discounted_cash": 13.0, "minimum": 10.89, "maximum": 64.93, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14.17, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.4 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 58.42 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.58 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.4 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 64.93 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 64.93 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 21.69, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 20.24, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 15.33, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 23.86, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 15.18, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.63 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28.56 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.18, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 25.75 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.4 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26.94 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 23.86, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.81 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 23.68 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.69, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "OTHER HEPATOBILIARY, PANCREAS & ABDOMINAL PROCEDURES - SOI : 1", "code_information": [ { "code": "2641", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 22783.77, "maximum": 24150.8, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 23734.56 } ] } ] }, { "description": "PACEMAKER PHILOS II DR", "code_information": [ { "code": "C1785", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 6147.84, "10th_percentile": 6147.84, "90th_percentile": 6147.84, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 6147.84, "10th_percentile": 6147.84, "90th_percentile": 6147.84, "count": "1 through 10" } ] } ] }, { "description": "SCREW CAPTURED GOLD 5X25", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "TRYPSIN FECES QUAL", "code_information": [ { "code": "84488", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 140.0, "discounted_cash": 26.0, "minimum": 6.351, "maximum": 112.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7.15, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.3 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 29.49 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 6.35 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.3 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 32.78 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 32.78 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.95, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 10.22, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 7.74, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 7.67, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.92 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.42 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.67, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 13.0 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.3 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.6 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 7.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.0 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 7.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 11.95 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.95, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "Explore/treat finger joint", "code_information": [ { "code": "26080", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3535.0, "discounted_cash": 671.0, "minimum": 530.25, "maximum": 2828.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 640.82, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 1802.67 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 962.33 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 2005.98 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 2005.98 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 980.85, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 915.46, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 693.13, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1078.94, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 686.6, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 686.6, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1078.94, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 653.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 653.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 653.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 980.85, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "ABD PARACENTESIS W/IMAGING - 49083 - 964663", "code_information": [ { "code": "49083", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4131.95, "discounted_cash": 706.0, "minimum": 361.4534, "maximum": 3305.56, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 361.45, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 1045.27 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 558.0 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 1163.16 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 1163.16 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 553.25, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 516.36, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 390.96, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 608.57, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 387.27, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 387.27, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 608.57, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 368.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 368.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 368.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 553.25, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "MOUTH PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "138", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 3893.4358, "maximum": 12009.6, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 6987.46 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 8496.0 } ] } ] }, { "description": "Anti-Chromatin Ab, IgG", "code_information": [ { "code": "83516", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 137.5, "discounted_cash": 32.0, "minimum": 4.4625, "maximum": 436.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11.3, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.26 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 46.58 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 10.03 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.26 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 51.77 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 51.77 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 94.5, "10th_percentile": 94.5, "90th_percentile": 114.75, "count": "1 through 10" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17.3, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 16.14, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 12.22, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 30.38, "10th_percentile": 5.36, "90th_percentile": 96.03, "count": "1 through 10" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.02, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.24 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.76 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 20.53 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.26 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.47 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.02, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "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": "fee schedule", "standard_charge_dollar": 15.79 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 5.65, "10th_percentile": 5.65, "90th_percentile": 5.65, "count": "1 through 10" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 18.89 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.3, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "ASSAY OF HOMOCYSTEINE", "code_information": [ { "code": "83090", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 264.59, "discounted_cash": 50.0, "minimum": 15.5904, "maximum": 211.672, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17.56, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.29 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 72.4 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 15.59 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.29 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 80.46 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 80.46 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 179.92, "10th_percentile": 179.92, "90th_percentile": 179.92, "count": "1 through 10" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 26.88, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 25.09, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 19.0, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 29.57, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 18.82, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26.8 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 35.39 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.82, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 31.92 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.29 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 33.39 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 29.57, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 17.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.55 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 17.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 17.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 27.61 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 26.88, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "CULT VIRUS CPE", "code_information": [ { "code": "87252", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 257.0, "discounted_cash": 48.0, "minimum": 22.6809, "maximum": 205.6, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 25.55, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 36.79 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 105.32 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 22.68 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 36.79 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 117.05 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 117.05 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 39.11, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 36.5, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 27.63, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 43.02, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 27.37, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 39.0 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 51.49 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.37, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 46.44 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 36.79 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 48.58 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 43.02, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 26.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 35.72 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 26.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 26.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 42.67 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 39.11, "additional_payer_notes": "150.00% 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", "minimum": 14243.7592, "maximum": 29088.9, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 29088.9 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 29079.29 } ] } ] }, { "description": "GUIDEWIRE ASAHI PROWATER 300CM", "code_information": [ { "code": "C1769", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 228.66, "10th_percentile": 43.17, "90th_percentile": 1333.19, "count": "49" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 200.16, "10th_percentile": 45.57, "90th_percentile": 746.52, "count": "29" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 130.22, "10th_percentile": 39.18, "90th_percentile": 442.41, "count": "15" } ] } ] }, { "description": "CATH PTCA 80CMX20M OD7M", "code_information": [ { "code": "C1725", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 462.76, "10th_percentile": 256.45, "90th_percentile": 2515.23, "count": "21" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 270.69, "10th_percentile": 106.59, "90th_percentile": 1342.29, "count": "14" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 484.0, "10th_percentile": 143.56, "90th_percentile": 543.74, "count": "1 through 10" } ] } ] }, { "description": "STENT RX XIENCE 3.5X12STENT RX", "code_information": [ { "code": "C1876", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 3100.8, "10th_percentile": 1880.29, "90th_percentile": 7522.24, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 3482.69, "10th_percentile": 3482.69, "90th_percentile": 3482.69, "count": "1 through 10" } ] } ] }, { "description": "STENT XIENCE ALPINE 3X15MM", "code_information": [ { "code": "C1874", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 4258.8, "10th_percentile": 4258.8, "90th_percentile": 4420.0, "count": "1 through 10" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1456.46, "10th_percentile": 975.0, "90th_percentile": 4680.0, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1444.95, "10th_percentile": 1444.95, "90th_percentile": 1444.95, "count": "1 through 10" } ] } ] }, { "description": "PACEMAKER VICTORY DR5810", "code_information": [ { "code": "C1785", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 6147.84, "10th_percentile": 6147.84, "90th_percentile": 6147.84, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 6147.84, "10th_percentile": 6147.84, "90th_percentile": 6147.84, "count": "1 through 10" } ] } ] }, { "description": "RUSH PINS 802-01-07", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "CATH CORD IM 6FR", "code_information": [ { "code": "C1894", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 112.23, "10th_percentile": 28.87, "90th_percentile": 279.68, "count": "37" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 99.92, "10th_percentile": 25.71, "90th_percentile": 152.65, "count": "26" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 94.66, "10th_percentile": 56.02, "90th_percentile": 112.23, "count": "11" } ] } ] }, { "description": "Colonoscopy w/ablation", "code_information": [ { "code": "45388", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2651.25, "discounted_cash": 715.0, "minimum": 397.6875, "maximum": 3011.04, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 476.89, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 1335.61 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 713.0 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 1486.25 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 1486.25 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 4200.0, "10th_percentile": 4200.0, "90th_percentile": 4200.0, "count": "1 through 10" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 729.93, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 681.27, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 515.82, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 565.78, "10th_percentile": 565.78, "90th_percentile": 3372.23, "count": "1 through 10" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 802.92, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 510.95, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 510.95, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 802.92, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 486.62, "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": 19.0, "median_amount": 3562.5, "10th_percentile": 3562.5, "90th_percentile": 3562.5, "count": "1 through 10" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 486.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 486.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1067.0, "10th_percentile": 1067.0, "90th_percentile": 1067.0, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 729.93, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "MONORAIL STENT 3.0X8MM", "code_information": [ { "code": "C1874", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 4258.8, "10th_percentile": 4258.8, "90th_percentile": 4420.0, "count": "1 through 10" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1456.46, "10th_percentile": 975.0, "90th_percentile": 4680.0, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1444.95, "10th_percentile": 1444.95, "90th_percentile": 1444.95, "count": "1 through 10" } ] } ] }, { "description": "DX BRONCHOSCOPE/LAVAGE", "code_information": [ { "code": "31624", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3446.04, "discounted_cash": 654.0, "minimum": 516.906, "maximum": 2756.832, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 709.34, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 1902.71 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 1015.73 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 2117.3 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 2117.3 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1085.73, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 1013.35, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 767.25, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1194.3, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 760.01, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 760.01, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1194.3, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 723.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 723.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 723.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1085.73, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "BLADE TFN HELICAL 105MM", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "ER ROOM - LEVEL 5", "code_information": [ { "code": "99285", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5000.0, "discounted_cash": 950.0, "minimum": 237.3364, "maximum": 4000.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 75.0, "median_amount": 3750.0, "10th_percentile": 1921.88, "90th_percentile": 3750.0, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 237.34, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 1412.63 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 459.1 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1569.03 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 1569.03 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 2800.0, "10th_percentile": 1742.5, "90th_percentile": 3400.0, "count": "51" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 363.27, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 339.05, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Gray Count Insurance MGMT Systems", "plan_name": "Gray County Insurance MGMT Systems", "methodology": "percent of total billed charges", "standard_charge_percentage": 50.0, "median_amount": 656.0, "10th_percentile": 656.0, "90th_percentile": 656.0, "count": "1 through 10" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 256.71, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 1500.0, "10th_percentile": 768.75, "90th_percentile": 1500.01, "count": "76" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 950.0, "10th_percentile": 546.84, "90th_percentile": 1976.54, "count": "360" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 1624.54, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 254.29, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 254.29, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange EPO/HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 27.55, "median_amount": 656.0, "10th_percentile": 656.0, "90th_percentile": 656.0, "count": "1 through 10" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 24.6, "median_amount": 1280.0, "10th_percentile": 656.0, "90th_percentile": 1672.8, "count": "65" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 24.6, "median_amount": 1400.8, "10th_percentile": 1400.8, "90th_percentile": 1672.8, "count": "1 through 10" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 399.6, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 242.18, "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": 24.6, "median_amount": 1060.9, "10th_percentile": 1060.9, "90th_percentile": 1067.0, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 950.0, "10th_percentile": 950.0, "90th_percentile": 950.0, "count": "222" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 242.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 242.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 950.0, "10th_percentile": 546.84, "90th_percentile": 1067.0, "count": "58" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 2631.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 363.27, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "NEONATE BIRTHWT 1000-1249G W OR WO OTHER SIGNIFICANT CONDITION - SOI : 3", "code_information": [ { "code": "6033", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 76132.76, "maximum": 80700.73, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 79309.85 } ] } ] }, { "description": "WIRE 1.1MM GUIDE/150MM LENGTH", "code_information": [ { "code": "C1769", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 228.66, "10th_percentile": 43.17, "90th_percentile": 1333.19, "count": "49" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 200.16, "10th_percentile": 45.57, "90th_percentile": 746.52, "count": "29" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 130.22, "10th_percentile": 39.18, "90th_percentile": 442.41, "count": "15" } ] } ] }, { "description": "GUIDEWIRE VASCULAR .035X260CM", "code_information": [ { "code": "C1769", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 228.66, "10th_percentile": 43.17, "90th_percentile": 1333.19, "count": "49" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 200.16, "10th_percentile": 45.57, "90th_percentile": 746.52, "count": "29" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 130.22, "10th_percentile": 39.18, "90th_percentile": 442.41, "count": "15" } ] } ] }, { "description": "Skin sub graft trnk/arm/leg", "code_information": [ { "code": "15271", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4860.63, "discounted_cash": 923.0, "minimum": 294.539, "maximum": 3888.504, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 294.54, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 2158.24 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 1152.15 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 2401.66 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 2401.66 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 450.83, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 420.77, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 318.58, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 495.91, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 315.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 315.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 495.91, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 300.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 300.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 300.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 450.83, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "VENT MGMT INITIAL DAY", "code_information": [ { "code": "94002", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3446.68, "discounted_cash": 654.0, "minimum": 168.0, "maximum": 2757.344, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 246.2, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 1258.88 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 404.14 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1398.24 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 1398.24 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 376.83, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 351.71, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 266.29, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 620.4, "10th_percentile": 620.4, "90th_percentile": 620.4, "count": "1 through 10" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 414.51, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 263.78, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 263.78, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 414.51, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 251.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 251.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 251.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 168.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 376.83, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "MRI LT LOWER EXT NON JNT W/WO", "code_information": [ { "code": "73720", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5647.13, "discounted_cash": 1072.0, "minimum": 139.0326, "maximum": 4517.704, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 139.03, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 475.54 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 1542.67 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 332.21 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 475.54 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1714.51 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 1714.51 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 212.81, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 198.62, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 150.38, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 234.09, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 148.96, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 504.07 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 665.57 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 148.96, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 600.2 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 475.54 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 627.9 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 234.09, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 141.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 461.69 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 141.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 141.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1072.95, "10th_percentile": 1072.95, "90th_percentile": 1072.95, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 591.5 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 212.81, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "CORT SCREW 2319-32", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "MAJOR CRANIALFACIAL BONE PROCEDURES - SOI : 2", "code_information": [ { "code": "0892", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 27565.52, "maximum": 29219.46, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 28715.86 } ] } ] }, { "description": "2.7 CORTEX SCREW 8", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "PLATE CONTOUR 82MM 4 HOLE", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "CATH MONORAIL 15MMX4.5", "code_information": [ { "code": "C1725", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 462.76, "10th_percentile": 256.45, "90th_percentile": 2515.23, "count": "21" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 270.69, "10th_percentile": 106.59, "90th_percentile": 1342.29, "count": "14" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 484.0, "10th_percentile": 143.56, "90th_percentile": 543.74, "count": "1 through 10" } ] } ] }, { "description": "BEHAVIORAL DISORDERS - SOI : 3", "code_information": [ { "code": "7583", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 4791.31, "maximum": 5078.78, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 4991.25 } ] } ] }, { "description": "MALIGNANT BREAST DISORDERS - SOI : 2", "code_information": [ { "code": "3822", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 10329.43, "maximum": 10949.2, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 10760.49 } ] } ] }, { "description": "SCREW BNE ST STRDRV 3.5X52MM", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "ACHILLIES TENDON", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "ADENOSINE - 17478054420", "drug_information": { "unit": 1.0, "type": "ML" }, "code_information": [ { "code": "17478054420", "type": "NDC" }, { "code": "J0153", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 9.62, "10th_percentile": 9.62, "90th_percentile": 10.15, "count": "1 through 10" } ] } ] }, { "description": "HEMOSIDERIN QUAL", "code_information": [ { "code": "83070", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 141.0, "discounted_cash": 26.0, "minimum": 4.1325, "maximum": 112.8, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4.66, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.71 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 19.19 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 4.13 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.71 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 21.33 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 21.33 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7.13, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 6.65, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 5.04, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.84, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 4.99, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.11 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.38 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.99, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 8.46 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.71 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.85 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.84, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "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": "fee schedule", "standard_charge_dollar": 6.51 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 7.78 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.13, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "PM AZURE S DR MRI DRIMEEM", "code_information": [ { "code": "C1785", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 6147.84, "10th_percentile": 6147.84, "90th_percentile": 6147.84, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 6147.84, "10th_percentile": 6147.84, "90th_percentile": 6147.84, "count": "1 through 10" } ] } ] }, { "description": "ADJUSTMENT DISORDERS & NEUROSES EXCEPT DEPRESSIVE DIAGNOSES - SOI : 1", "code_information": [ { "code": "7551", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 3017.84, "maximum": 3198.91, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 3143.78 } ] } ] }, { "description": "ISLET CELL AB", "code_information": [ { "code": "86341", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 274.0, "discounted_cash": 52.0, "minimum": 20.5059, "maximum": 328.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 23.1, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 33.26 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 95.22 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 20.51 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 33.26 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 105.83 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 105.83 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 35.36, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 33.0, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 24.98, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 38.89, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 24.75, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 35.25 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 46.55 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.75, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 41.98 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 33.26 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 43.91 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 38.89, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "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": "fee schedule", "standard_charge_dollar": 32.29 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 23.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 23.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 32.39 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 35.36, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "PLATE VA-LCP 4.5X195 8HL RT", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "DRILL BIT PERCUTANEOUS 16MM", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "OTHER OPEN CRANIOTOMY- SOI : 3", "code_information": [ { "code": "0273", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 52918.28, "maximum": 56093.38, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 55126.61 } ] } ] }, { "description": "DIGESTIVE MALIGNANCY - SOI : 1", "code_information": [ { "code": "2401", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 9992.31, "maximum": 10591.85, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 10409.3 } ] } ] }, { "description": "CRANIOTOMY FOR MULTIPLE SIGNIFICANT TRAUMA - SOI : 1", "code_information": [ { "code": "9101", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 32598.45, "maximum": 34554.35, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 33958.81 } ] } ] }, { "description": "CATH MAVERICK 5.5/15/150", "code_information": [ { "code": "C1725", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 462.76, "10th_percentile": 256.45, "90th_percentile": 2515.23, "count": "21" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 270.69, "10th_percentile": 106.59, "90th_percentile": 1342.29, "count": "14" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 484.0, "10th_percentile": 143.56, "90th_percentile": 543.74, "count": "1 through 10" } ] } ] }, { "description": "SCREW SELF TAPPING T8 2.7X22MM", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "CORTEX SCREW SLF TPNG 1.5X12", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "REPAIR INCOMPLETE CIRCUMCISION", "code_information": [ { "code": "54163", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6365.0, "discounted_cash": 1209.0, "minimum": 833.0686, "maximum": 5092.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 833.07, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 2356.16 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 1257.8 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 2621.89 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 2621.89 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1275.11, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 1190.1, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 901.07, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1402.62, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 892.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 892.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1402.62, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 850.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 850.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 850.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1275.11, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "BILIRUBIN TOTAL BODY FLUID LC", "code_information": [ { "code": "82247", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 176.25, "discounted_cash": 20.0, "minimum": 4.3674, "maximum": 141.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4.92, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.09 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 20.28 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 4.37 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.09 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 22.54 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 22.54 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 73.95, "10th_percentile": 73.95, "90th_percentile": 73.95, "count": "1 through 10" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7.53, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 7.03, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 5.32, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.28, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5.27, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.51 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.92 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.27, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 8.94 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.09 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.36 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.28, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.88 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 8.21 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.53, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "MRI T-SPINE W/O CONT", "code_information": [ { "code": "72146", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4499.0, "discounted_cash": 854.0, "minimum": 95.0796, "maximum": 3599.2, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 95.08, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 303.0 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 941.48 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 202.74 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 303.0 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1046.35 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 1046.35 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 145.53, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 135.83, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 102.84, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 2653.38, "10th_percentile": 2412.17, "90th_percentile": 2653.38, "count": "1 through 10" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 960.09, "10th_percentile": 854.81, "90th_percentile": 1887.44, "count": "12" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 160.08, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 101.87, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 321.17 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 424.08 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 101.87, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 382.42 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 303.0 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 400.07 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 160.08, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 97.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 294.17 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 854.81, "10th_percentile": 854.81, "90th_percentile": 854.81, "count": "11" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 97.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 97.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 960.09, "10th_percentile": 809.82, "90th_percentile": 960.09, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 353.74 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 145.53, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "PACEMAKER DUAL CHAMBER - C1785 - 050975", "code_information": [ { "code": "C1785", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 6147.84, "10th_percentile": 6147.84, "90th_percentile": 6147.84, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 6147.84, "10th_percentile": 6147.84, "90th_percentile": 6147.84, "count": "1 through 10" } ] } ] }, { "description": "MUSCULOSKELETAL MALIGNANCY & PATHOL FRACTURE DT MUSCSKEL MALIG - SOI : 3", "code_information": [ { "code": "3433", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 20063.89, "maximum": 21267.72, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 20901.17 } ] } ] }, { "description": "PLATE SD RISK FUSION PLATE", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "TRAUMATIC INJURY WITHOUT MCC", "code_information": [ { "code": "914", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 4103.5548, "maximum": 19515.6, "payers_information": [ { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "other", "standard_charge_dollar": 11700.0, "standard_charge_algorithm": "$4,500 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 28500.0, "10th_percentile": 28500.0, "90th_percentile": 28500.0, "count": "1 through 10" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 6861.75 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 8489.29 } ] } ] }, { "description": "CESAREAN SECTION WITH STERILIZATION- SOI : 4", "code_information": [ { "code": "5394", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 27804.28, "maximum": 40622.62, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 40622.62 } ] } ] }, { "description": "CARDIZEM - 17478093710", "drug_information": { "unit": 10.0, "type": "ML" }, "code_information": [ { "code": "17478093710", "type": "NDC" }, { "code": "J3490", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 4.72, "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 2.28, "10th_percentile": 0.64, "90th_percentile": 22.8, "count": "56" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 5.47, "10th_percentile": 1.14, "90th_percentile": 22.8, "count": "54" } ] } ] }, { "description": "CATHETER GUIDING AR 1", "code_information": [ { "code": "C1887", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 115.24, "10th_percentile": 81.0, "90th_percentile": 503.66, "count": "23" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 156.51, "10th_percentile": 102.6, "90th_percentile": 572.45, "count": "11" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 129.36, "10th_percentile": 24.35, "90th_percentile": 512.12, "count": "1 through 10" } ] } ] }, { "description": "CIRRHOSIS AND ALCOHOLIC HEPATITIS WITHOUT CCMCC", "code_information": [ { "code": "434", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 2861.3128, "maximum": 15762.6, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 5685.06 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 6830.74 } ] } ] }, { "description": "ANTEPARTUM WITH O.R. PROCEDURE- SOI : 4", "code_information": [ { "code": "5474", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 40169.8, "maximum": 42579.99, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 41846.12 } ] } ] }, { "description": "ADRENAL PROCEDURES - SOI : 4", "code_information": [ { "code": "4014", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 59248.11, "maximum": 62803.0, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 61720.59 } ] } ] }, { "description": "CATH MAVERICK 2 9MM X2.5", "code_information": [ { "code": "C1725", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 462.76, "10th_percentile": 256.45, "90th_percentile": 2515.23, "count": "21" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 270.69, "10th_percentile": 106.59, "90th_percentile": 1342.29, "count": "14" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 484.0, "10th_percentile": 143.56, "90th_percentile": 543.74, "count": "1 through 10" } ] } ] }, { "description": "RHINO TRACH INTRODUCER6F", "code_information": [ { "code": "C1769", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 228.66, "10th_percentile": 43.17, "90th_percentile": 1333.19, "count": "49" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 200.16, "10th_percentile": 45.57, "90th_percentile": 746.52, "count": "29" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 130.22, "10th_percentile": 39.18, "90th_percentile": 442.41, "count": "15" } ] } ] }, { "description": "IMPLANTABLE HEART ASSIST SYSTEMS- SOI : 3", "code_information": [ { "code": "1613", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 232381.65, "maximum": 246324.55, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 242079.16 } ] } ] }, { "description": "RUSH PIN ZIMMER 6.4X356MM", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "SCRW TI LKNG STARDRIVE 4.0X36M", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "STENT INTEGRITY RX 2.7X18MM", "code_information": [ { "code": "C1876", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 3100.8, "10th_percentile": 1880.29, "90th_percentile": 7522.24, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 3482.69, "10th_percentile": 3482.69, "90th_percentile": 3482.69, "count": "1 through 10" } ] } ] }, { "description": "MONORAIL STENT 20MMX3.5", "code_information": [ { "code": "C1876", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 3100.8, "10th_percentile": 1880.29, "90th_percentile": 7522.24, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 3482.69, "10th_percentile": 3482.69, "90th_percentile": 3482.69, "count": "1 through 10" } ] } ] }, { "description": "UNLISTED LAPS PX OVIDCT OVRY", "code_information": [ { "code": "58679", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 26250.0, "discounted_cash": 4987.0, "minimum": 2409.3006, "maximum": 21000.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2409.3, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 6428.83 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 3431.93 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 7153.89 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 7153.89 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3687.71, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 3441.86, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 2605.98, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4056.48, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2581.39, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2581.39, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4056.48, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2458.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2458.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 2458.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3687.71, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "CORONARY BYPASS WITH PTCA WITHOUT MCC", "code_information": [ { "code": "232", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 27238.3494, "maximum": 58122.1462, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 57985.4 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 58122.15 } ] } ] }, { "description": "CT FACIAL BONE W CONTRAS", "code_information": [ { "code": "70487", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3267.0, "discounted_cash": 620.0, "minimum": 69.8936, "maximum": 2613.6, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 69.89, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 227.2 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 736.17 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 158.53 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 227.2 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 818.17 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 818.17 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 106.98, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 99.85, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 75.6, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 980.1, "10th_percentile": 980.1, "90th_percentile": 980.1, "count": "1 through 10" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 620.73, "10th_percentile": 620.73, "90th_percentile": 633.8, "count": "1 through 10" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 117.68, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 74.89, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 240.83 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 317.99 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 74.89, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 286.75 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 227.2 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 299.99 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 117.68, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 71.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 220.58 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 71.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 71.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 620.73, "10th_percentile": 620.73, "90th_percentile": 620.73, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 298.8 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 106.98, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "BACTERIAL VAGINOSIS NAA", "code_information": [ { "code": "87798", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 250.0, "discounted_cash": 33.0, "minimum": 7.5, "maximum": 749.52, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 34.39, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 49.51 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 141.76 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 30.53 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 49.51 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 157.55 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 157.55 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 98.25, "10th_percentile": 98.25, "90th_percentile": 98.25, "count": "1 through 10" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 52.64, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 49.13, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 37.2, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 57.9, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 36.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 52.48 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 69.3 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 62.49 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 49.51 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 65.38 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 57.9, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 48.07 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 57.44 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 52.64, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "CATH BALLOON POWERFLEX 6MMX4CM", "code_information": [ { "code": "C1725", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 462.76, "10th_percentile": 256.45, "90th_percentile": 2515.23, "count": "21" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 270.69, "10th_percentile": 106.59, "90th_percentile": 1342.29, "count": "14" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 484.0, "10th_percentile": 143.56, "90th_percentile": 543.74, "count": "1 through 10" } ] } ] }, { "description": "PLATE VA-LCP CLAVICLE 2.7SHAFT", "code_information": [ { "code": "C1776", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 4588.1, "10th_percentile": 1617.12, "90th_percentile": 11630.3, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 9120.0, "10th_percentile": 9120.0, "90th_percentile": 9120.0, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 8640.0, "10th_percentile": 8640.0, "90th_percentile": 9120.0, "count": "1 through 10" } ] } ] }, { "description": "CULTURE STOOL", "code_information": [ { "code": "87045", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 244.75, "discounted_cash": 46.0, "minimum": 8.2128, "maximum": 195.8, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.25, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.33 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 38.14 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 8.21 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.33 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 42.39 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 42.39 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 166.43, "10th_percentile": 137.06, "90th_percentile": 166.43, "count": "1 through 10" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14.16, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 13.22, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 10.01, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 120.75, "10th_percentile": 120.75, "90th_percentile": 120.75, "count": "1 through 10" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 46.5, "10th_percentile": 9.44, "90th_percentile": 52.23, "count": "1 through 10" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15.58, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 9.91, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.13 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.65 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.91, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 16.82 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.33 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.6 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.58, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "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": "fee schedule", "standard_charge_dollar": 12.94 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 9.44, "10th_percentile": 9.44, "90th_percentile": 46.5, "count": "1 through 10" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 9.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 9.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 38.15, "10th_percentile": 9.44, "90th_percentile": 44.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 15.46 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.16, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "POLAR-CATH .014 3/60/135", "code_information": [ { "code": "C1725", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 462.76, "10th_percentile": 256.45, "90th_percentile": 2515.23, "count": "21" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 270.69, "10th_percentile": 106.59, "90th_percentile": 1342.29, "count": "14" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 484.0, "10th_percentile": 143.56, "90th_percentile": 543.74, "count": "1 through 10" } ] } ] }, { "description": "HEMOGLOBIN A1C", "code_information": [ { "code": "83036", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 161.0, "discounted_cash": 2.0, "minimum": 1.71, "maximum": 128.8, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 75.0, "median_amount": 120.75, "10th_percentile": 120.75, "90th_percentile": 120.75, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.52, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.71 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 39.23 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 8.45 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.71 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 43.6 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 43.6 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 109.48, "10th_percentile": 90.16, "90th_percentile": 109.48, "count": "52" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 13.59, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 10.29, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 30.59, "10th_percentile": 9.71, "90th_percentile": 34.36, "count": "177" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.02, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 10.2, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.53 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.19 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.2, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 17.3 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.71 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.1 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.02, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 9.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.31 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 30.59, "10th_percentile": 9.71, "90th_percentile": 30.59, "count": "92" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 9.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 9.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 30.59, "10th_percentile": 28.98, "90th_percentile": 34.36, "count": "38" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 15.89 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "TFNA HELICAL BLADE 100MM", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "GUIDEWIRE HI TORQUE BMW ELITE", "code_information": [ { "code": "C1769", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 228.66, "10th_percentile": 43.17, "90th_percentile": 1333.19, "count": "49" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 200.16, "10th_percentile": 45.57, "90th_percentile": 746.52, "count": "29" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 130.22, "10th_percentile": 39.18, "90th_percentile": 442.41, "count": "15" } ] } ] }, { "description": "CONTUSION, OPEN WOUND & OTHER TRAUMA TO SKIN & SUBCUTANEOUS TISSUE - SOI : 3", "code_information": [ { "code": "3843", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 14985.12, "maximum": 15884.23, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 15610.47 } ] } ] }, { "description": "FEMORAL COMPONENT SPHERE SZ5 L", "code_information": [ { "code": "C1776", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 4588.1, "10th_percentile": 1617.12, "90th_percentile": 11630.3, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 9120.0, "10th_percentile": 9120.0, "90th_percentile": 9120.0, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 8640.0, "10th_percentile": 8640.0, "90th_percentile": 9120.0, "count": "1 through 10" } ] } ] }, { "description": "ANTIADRENAL AB QUANT LC", "code_information": [ { "code": "86255", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 73.3, "discounted_cash": 45.0, "minimum": 10.4835, "maximum": 200.8, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11.81, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.01 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 48.68 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 10.48 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.01 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 54.1 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 54.1 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.08, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 12.77, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.88, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.03 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.8 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 21.46 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.01 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.45 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.88, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.51 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 19.73 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.08, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "OTHER MALE REPRODUCTIVE SYSTEM DIAGNOSES WITH CCMCC", "code_information": [ { "code": "729", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 4640.1664, "maximum": 23268.6, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 10450.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 10149.76 } ] } ] }, { "description": "CATH MAVERICK 20MM X 1.5", "code_information": [ { "code": "C1725", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 462.76, "10th_percentile": 256.45, "90th_percentile": 2515.23, "count": "21" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 270.69, "10th_percentile": 106.59, "90th_percentile": 1342.29, "count": "14" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 484.0, "10th_percentile": 143.56, "90th_percentile": 543.74, "count": "1 through 10" } ] } ] }, { "description": "SINGLE LEAD REPAIR", "code_information": [ { "code": "33218", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6633.0, "discounted_cash": 1260.0, "minimum": 994.95, "maximum": 5306.4, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1489.29, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 3968.73 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 2118.65 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 4416.33 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 4416.33 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2279.52, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 2127.55, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 1610.86, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2507.47, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1595.66, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1595.66, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2507.47, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1519.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1519.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 1519.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2279.52, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "CONCENTRATION INFECTIOUS AGENT", "code_information": [ { "code": "87015", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 125.0, "discounted_cash": 23.0, "minimum": 5.8116, "maximum": 100.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.55, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.42 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 26.99 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5.81 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.42 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 29.99 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 29.99 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.02, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 9.35, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 7.08, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11.02, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 7.01, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.99 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.19 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.01, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 11.9 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.42 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.44 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.02, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 6.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.15 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 6.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 10.93 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.02, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "PACEMAKER ASSURITY PM2240", "code_information": [ { "code": "C1785", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 6147.84, "10th_percentile": 6147.84, "90th_percentile": 6147.84, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 6147.84, "10th_percentile": 6147.84, "90th_percentile": 6147.84, "count": "1 through 10" } ] } ] }, { "description": "INCLINATION SET 22MM", "code_information": [ { "code": "C1776", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 4588.1, "10th_percentile": 1617.12, "90th_percentile": 11630.3, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 9120.0, "10th_percentile": 9120.0, "90th_percentile": 9120.0, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 8640.0, "10th_percentile": 8640.0, "90th_percentile": 9120.0, "count": "1 through 10" } ] } ] }, { "description": "MALNUTRITION, FAILURE TO THRIVE & OTHER NUTRITIONAL DISORDERS - SOI : 1", "code_information": [ { "code": "4211", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 7443.38, "maximum": 7889.98, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 7754.0 } ] } ] }, { "description": "CORT SCREW 2319-52", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "STENT ABSOLUTE PRO 6.0X100X135", "code_information": [ { "code": "C1876", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 3100.8, "10th_percentile": 1880.29, "90th_percentile": 7522.24, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 3482.69, "10th_percentile": 3482.69, "90th_percentile": 3482.69, "count": "1 through 10" } ] } ] }, { "description": "TX PROX HUMERAL FX W/MAN CLSD", "code_information": [ { "code": "23605", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3341.14, "discounted_cash": 634.0, "minimum": 501.171, "maximum": 2672.912, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 640.82, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 1802.67 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 962.33 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 2005.98 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 2005.98 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 980.85, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 915.46, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 693.13, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1078.94, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 686.6, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 686.6, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1078.94, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 653.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 653.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 653.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 980.85, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "FEMALE REPRODUCTIVE SYSTEM INFECTIONS - SOI : 1", "code_information": [ { "code": "5311", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 5740.59, "maximum": 6085.02, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 5980.15 } ] } ] }, { "description": "R&L HEART CATH NO LV GRAM", "code_information": [ { "code": "93456", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 20413.1, "discounted_cash": 3878.0, "minimum": 1292.0026, "maximum": 16330.48, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1292.0, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 4702.42 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 2023.46 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 5215.41 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 5215.41 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1977.56, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 1845.72, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 1397.47, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2175.31, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1384.29, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1384.29, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2175.31, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1318.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1318.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 1318.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1977.56, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "MESH PROGRIP 10 X 15CM", "code_information": [ { "code": "C1781", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1862.28, "10th_percentile": 1862.28, "90th_percentile": 11852.02, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1206.78, "10th_percentile": 1206.78, "90th_percentile": 1206.78, "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", "minimum": 4608.3022, "maximum": 12009.6, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 7101.19 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 8243.86 } ] } ] }, { "description": "DESTINATION SHEATH 6FR 90CM", "code_information": [ { "code": "C1887", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 115.24, "10th_percentile": 81.0, "90th_percentile": 503.66, "count": "23" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 156.51, "10th_percentile": 102.6, "90th_percentile": 572.45, "count": "11" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 129.36, "10th_percentile": 24.35, "90th_percentile": 512.12, "count": "1 through 10" } ] } ] }, { "description": "DISORDERS OF PANCREAS EXCEPT MALIGNANCY - SOI : 4", "code_information": [ { "code": "2824", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 53068.22, "maximum": 56252.31, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 55282.81 } ] } ] }, { "description": "Treat knee fracture - 27536 - ", "code_information": [ { "code": "27536", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10178.75, "discounted_cash": 1933.0, "minimum": 877.4, "maximum": 8143.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2891.8, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 1643.59 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 877.4 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 1828.95 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 1828.95 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4426.23, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 4131.15, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 3127.87, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4868.85, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3098.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3098.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4868.85, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2950.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2950.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 2950.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4426.23, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "STENT INTEGRITY RX 3.0X15MM - C1876 - 900216", "code_information": [ { "code": "C1876", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 3100.8, "10th_percentile": 1880.29, "90th_percentile": 7522.24, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 3482.69, "10th_percentile": 3482.69, "90th_percentile": 3482.69, "count": "1 through 10" } ] } ] }, { "description": "SCREW CORTICLE 4.5X44M", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "ABORTION WITH D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY- SOI : 1", "code_information": [ { "code": "5431", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 5476.05, "maximum": 5804.61, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 5704.57 } ] } ] }, { "description": "CORONARY BYPASS W AMI OR COMPLEX PDX - SOI : 1", "code_information": [ { "code": "1651", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 43116.97, "maximum": 45703.99, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 44916.28 } ] } ] }, { "description": "SYNCOPE & COLLAPSE - SOI : 1", "code_information": [ { "code": "2041", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 6153.16, "maximum": 6522.34, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 6409.93 } ] } ] }, { "description": "INJ CORP CAVRNOSA W/PHARM AGNT", "code_information": [ { "code": "54235", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1330.7, "discounted_cash": 252.0, "minimum": 31.01, "maximum": 1064.56, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 99.57, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 41.92 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 31.01 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 46.73 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 46.73 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 152.4, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 142.24, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 107.7, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 167.64, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 106.68, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 106.68, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 167.64, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 101.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 101.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 101.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 152.4, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "PATELLA RESURFACING SIZE 1 - C1776 - 052142", "code_information": [ { "code": "C1776", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 4588.1, "10th_percentile": 1617.12, "90th_percentile": 11630.3, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 9120.0, "10th_percentile": 9120.0, "90th_percentile": 9120.0, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 8640.0, "10th_percentile": 8640.0, "90th_percentile": 9120.0, "count": "1 through 10" } ] } ] }, { "description": "CORT SCREW 2323-32", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "medical team conference face t", "code_information": [ { "code": "99366", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1377.9, "discounted_cash": 261.0, "minimum": 37.3143, "maximum": 1102.32, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 116.23 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 37.31 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 129.1 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 129.1 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 79.0 } ] } ] }, { "description": "DRUG TEST PRSMV INSTRMNT", "code_information": [ { "code": "80306", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 227.5, "discounted_cash": 43.0, "minimum": 14.2035, "maximum": 182.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 16.8, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.18 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 69.25 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 14.91 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.18 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 76.96 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 76.96 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 25.71, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 24.0, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 18.17, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 28.28, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 18.0, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.64 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 33.85 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.0, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 30.52 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.18 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.93 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 28.28, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 17.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.48 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 17.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 17.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 23.94 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 25.71, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "SURG PATH LEVEL 5", "code_information": [ { "code": "88307", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1875.42, "discounted_cash": 356.0, "minimum": 73.76, "maximum": 1500.336, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 142.84, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 1144.98 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 246.57 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1272.51 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 1272.51 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 218.64, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 204.06, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 154.51, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 240.5, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 153.05, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 153.05, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 240.5, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 145.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 145.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 145.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 73.76 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 218.64, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "STENT INTEGRITY RX2.5X12MM", "code_information": [ { "code": "C1874", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 4258.8, "10th_percentile": 4258.8, "90th_percentile": 4420.0, "count": "1 through 10" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1456.46, "10th_percentile": 975.0, "90th_percentile": 4680.0, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1444.95, "10th_percentile": 1444.95, "90th_percentile": 1444.95, "count": "1 through 10" } ] } ] }, { "description": "GLUCAGEN", "drug_information": { "unit": 1.0, "type": "ML" }, "code_information": [ { "code": "00597026010", "type": "NDC" }, { "code": "J1610", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 292.96, "10th_percentile": 292.96, "90th_percentile": 292.96, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 260.83, "10th_percentile": 260.83, "90th_percentile": 260.83, "count": "1 through 10" } ] } ] }, { "description": "RESPIRATORY INFECTIONS AND INFLAMMATIONS WITHOUT CCMCC", "code_information": [ { "code": "179", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 4022.7398, "maximum": 18765.0, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 6827.54 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 7238.19 } ] } ] }, { "description": "MRI BILAT UPPER EXT JOINT", "code_information": [ { "code": "73221", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3873.75, "discounted_cash": 759.0, "minimum": 95.0796, "maximum": 3212.12, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 95.08, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 303.0 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 941.48 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 202.74 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 303.0 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1046.35 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 1046.35 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 2239.3, "10th_percentile": 2239.3, "90th_percentile": 3415.43, "count": "1 through 10" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 145.53, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 135.83, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 102.84, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 1199.63, "10th_percentile": 1199.63, "90th_percentile": 2499.0, "count": "1 through 10" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 759.76, "10th_percentile": 719.78, "90th_percentile": 1071.84, "count": "12" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 160.08, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 101.87, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 321.17 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 424.08 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 101.87, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 382.42 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 303.0 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 400.07 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 160.08, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 97.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 294.17 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 759.76, "10th_percentile": 759.76, "90th_percentile": 759.76, "count": "1 through 10" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 97.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 97.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 719.78, "10th_percentile": 719.78, "90th_percentile": 719.78, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 353.74 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 145.53, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "STENT EXPRESS 2 2.75X12M", "code_information": [ { "code": "C1876", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 3100.8, "10th_percentile": 1880.29, "90th_percentile": 7522.24, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 3482.69, "10th_percentile": 3482.69, "90th_percentile": 3482.69, "count": "1 through 10" } ] } ] }, { "description": "MULTIPLE SCLEROSIS, OTHER DEMYELINATING DISEASE AND INFLAMMATORY NEUROPATHIES- SOI : 1", "code_information": [ { "code": "0431", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 11853.63, "maximum": 12564.85, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 12348.3 } ] } ] }, { "description": "SCREW CANNULATED LOCKING 5X45M", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "DESTINATION SHEATH 7FR 45CM", "code_information": [ { "code": "C1887", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 115.24, "10th_percentile": 81.0, "90th_percentile": 503.66, "count": "23" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 156.51, "10th_percentile": 102.6, "90th_percentile": 572.45, "count": "11" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 129.36, "10th_percentile": 24.35, "90th_percentile": 512.12, "count": "1 through 10" } ] } ] }, { "description": "POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "858", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 6226.9112, "maximum": 24769.8, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 10733.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 13353.73 } ] } ] }, { "description": "Partial removal of foot bone", "code_information": [ { "code": "28122", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3093.13, "discounted_cash": 587.0, "minimum": 463.9695, "maximum": 3093.13, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1303.98, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 3093.13 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 1943.59 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 3093.13 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 3093.13 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1995.89, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 1862.83, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 1410.43, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2195.47, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1397.12, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1397.12, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2195.47, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1330.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1330.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 1330.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1995.89, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "ANA COMPREHENSIVE PANEL", "code_information": [ { "code": "86225", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 481.59, "discounted_cash": 305.0, "minimum": 11.3355, "maximum": 1287.08, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13.47, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.38 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 55.51 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 11.95 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.38 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 61.69 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 61.69 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 51.39, "10th_percentile": 38.76, "90th_percentile": 269.69, "count": "1 through 10" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 20.61, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 19.24, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 14.56, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 14.36, "10th_percentile": 12.16, "90th_percentile": 121.35, "count": "1 through 10" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 22.67, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 14.43, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.55 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.13 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.43, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 24.47 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.38 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.6 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 22.67, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "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": "fee schedule", "standard_charge_dollar": 18.82 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 91.5, "10th_percentile": 14.36, "90th_percentile": 305.68, "count": "1 through 10" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 13.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 22.49 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 20.61, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "HEART TRANSPLANT OR IMPLANT OF HEART ASSIST SYSTEM WITH MCC", "code_information": [ { "code": "001", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 128250.0, "maximum": 328679.0, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 328679.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 268665.13 } ] } ] }, { "description": "OTHER COMPLICATIONS OF TREATMENT - SOI : 3", "code_information": [ { "code": "8133", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 14690.98, "maximum": 15572.44, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 15304.05 } ] } ] }, { "description": "STENT INTEGRITY RX 2.75X26MM", "code_information": [ { "code": "C1874", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 4258.8, "10th_percentile": 4258.8, "90th_percentile": 4420.0, "count": "1 through 10" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1456.46, "10th_percentile": 975.0, "90th_percentile": 4680.0, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1444.95, "10th_percentile": 1444.95, "90th_percentile": 1444.95, "count": "1 through 10" } ] } ] }, { "description": "CATH NANOCROSS ELITE 2.0X120MM", "code_information": [ { "code": "C1725", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 462.76, "10th_percentile": 256.45, "90th_percentile": 2515.23, "count": "21" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 270.69, "10th_percentile": 106.59, "90th_percentile": 1342.29, "count": "14" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 484.0, "10th_percentile": 143.56, "90th_percentile": 543.74, "count": "1 through 10" } ] } ] }, { "description": "TOTAL PROTEIN-IFE(REF)", "code_information": [ { "code": "84156", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 24.33, "discounted_cash": 4.0, "minimum": 3.1929, "maximum": 111.104, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3.6, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.18 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 14.83 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3.19 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.18 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 16.48 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 16.48 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5.51, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 5.14, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 3.89, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.06, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3.85, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.49 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.25 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.85, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 6.54 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.18 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.84 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.06, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.03 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 3.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 6.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5.51, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "COPPER BLD(REF)", "code_information": [ { "code": "82525", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 170.5, "discounted_cash": 10.0, "minimum": 8.43, "maximum": 136.4, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12.16, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.51 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 50.14 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 10.8 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.51 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 55.72 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 55.72 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 95.48, "10th_percentile": 95.48, "90th_percentile": 95.48, "count": "1 through 10" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.62, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 17.37, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 13.15, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 20.48, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 13.03, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.56 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.51 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.03, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 22.1 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.51 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.12 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.48, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "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": "fee schedule", "standard_charge_dollar": 17.0 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 10.68, "10th_percentile": 10.68, "90th_percentile": 32.4, "count": "1 through 10" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 12.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 20.32 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.62, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "PROTIEN SERUM", "code_information": [ { "code": "84155", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 74.42, "discounted_cash": 14.0, "minimum": 3.1929, "maximum": 59.536, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3.6, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.18 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 14.83 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3.19 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.18 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 16.48 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 16.48 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5.51, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 5.14, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 3.89, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.06, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3.85, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.49 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.25 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.85, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 6.54 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.18 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.84 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.06, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.03 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 3.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 6.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5.51, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "CTA LT UPPER EXTREMITY", "code_information": [ { "code": "73206", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2712.0, "discounted_cash": 515.0, "minimum": 69.8936, "maximum": 2712.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 69.89, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 227.2 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 736.17 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 158.53 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 227.2 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 818.17 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 818.17 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 106.98, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 99.85, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 75.6, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 117.68, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 74.89, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 240.83 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 317.99 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 74.89, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 286.75 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 227.2 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 299.99 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 117.68, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 71.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 220.58 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 71.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 71.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 350.35 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 106.98, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "H PYLORI AB QUAL(ML)", "code_information": [ { "code": "86677", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 253.0, "discounted_cash": 48.0, "minimum": 14.6595, "maximum": 202.4, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 16.51, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.77 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 68.07 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 14.66 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.77 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 75.66 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 75.66 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 156.4, "10th_percentile": 141.68, "90th_percentile": 172.04, "count": "16" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 25.28, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 23.59, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 17.86, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 48.07, "10th_percentile": 45.54, "90th_percentile": 53.99, "count": "39" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 27.8, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 17.69, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.2 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 33.27 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.69, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 30.0 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.77 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.39 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 27.8, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 16.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.08 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 48.07, "10th_percentile": 48.07, "90th_percentile": 48.07, "count": "35" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 16.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 45.54, "10th_percentile": 45.54, "90th_percentile": 48.07, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 23.76 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 25.28, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "GUIDEWIRE GLIDEX.035X260", "code_information": [ { "code": "C1769", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 228.66, "10th_percentile": 43.17, "90th_percentile": 1333.19, "count": "49" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 200.16, "10th_percentile": 45.57, "90th_percentile": 746.52, "count": "29" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 130.22, "10th_percentile": 39.18, "90th_percentile": 442.41, "count": "15" } ] } ] }, { "description": "FEMORAL STEM SZ 7", "code_information": [ { "code": "C1776", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 4588.1, "10th_percentile": 1617.12, "90th_percentile": 11630.3, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 9120.0, "10th_percentile": 9120.0, "90th_percentile": 9120.0, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 8640.0, "10th_percentile": 8640.0, "90th_percentile": 9120.0, "count": "1 through 10" } ] } ] }, { "description": "CATHETER FUIDE 8FR INTRO CONTR", "code_information": [ { "code": "C1894", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 112.23, "10th_percentile": 28.87, "90th_percentile": 279.68, "count": "37" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 99.92, "10th_percentile": 25.71, "90th_percentile": 152.65, "count": "26" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 94.66, "10th_percentile": 56.02, "90th_percentile": 112.23, "count": "11" } ] } ] }, { "description": "SPECTROPHOTOMETRY", "code_information": [ { "code": "84311", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 55.0, "discounted_cash": 10.0, "minimum": 7.047, "maximum": 44.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7.94, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.43 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 32.72 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 7.05 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.43 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 36.37 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 36.37 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12.15, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 11.34, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 8.59, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 13.37, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 8.51, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 12.12 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.0 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.51, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 14.43 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.43 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.1 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.37, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 8.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.1 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 8.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 11.45 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.15, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "CATH MAVERICK OTW 15M1.5", "code_information": [ { "code": "C1725", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 462.76, "10th_percentile": 256.45, "90th_percentile": 2515.23, "count": "21" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 270.69, "10th_percentile": 106.59, "90th_percentile": 1342.29, "count": "14" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 484.0, "10th_percentile": 143.56, "90th_percentile": 543.74, "count": "1 through 10" } ] } ] }, { "description": "CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITHOUT CCMCC", "code_information": [ { "code": "848", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 4751.922, "maximum": 20266.2, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 6232.36 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 8143.2 } ] } ] }, { "description": "RESTRATA FIBER MATRIX 100MG", "code_information": [ { "code": "A2026", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 142.26, "10th_percentile": 142.26, "90th_percentile": 10008.46, "count": "1 through 10" } ] } ] }, { "description": "Enhanced Liver Fibrosis", "code_information": [ { "code": "81517", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1907.5, "discounted_cash": 362.0, "minimum": 172.6662, "maximum": 1907.5, "payers_information": [ { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 185.0, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 290.71, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 176.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 176.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 176.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 211.43 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 264.29, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 172.67, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 1907.5 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 437.96 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1907.5 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 1907.5 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 264.29, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 246.67, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 186.76, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 290.71, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 185.0, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "OTHER ANEMIA & DISORDERS OF BLOOD & BLOOD-FORMING ORGANS - SOI : 2", "code_information": [ { "code": "6632", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 7999.2, "maximum": 8479.15, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 8333.01 } ] } ] }, { "description": "CATH BALLOON LEGEND 2.5X12", "code_information": [ { "code": "C1725", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 462.76, "10th_percentile": 256.45, "90th_percentile": 2515.23, "count": "21" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 270.69, "10th_percentile": 106.59, "90th_percentile": 1342.29, "count": "14" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 484.0, "10th_percentile": 143.56, "90th_percentile": 543.74, "count": "1 through 10" } ] } ] }, { "description": "MAJOR DEPRESSIVE DISORDERS & OTHERUNSPECIFIED PSYCHOSES - SOI : 1", "code_information": [ { "code": "7511", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 3794.27, "maximum": 4021.93, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 3952.61 } ] } ] }, { "description": "LYMPHOMA AND NON-ACUTE LEUKEMIA WITH CC", "code_information": [ { "code": "841", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 7484.8544, "maximum": 29273.4, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 13213.8 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 15640.23 } ] } ] }, { "description": "STENT RESOLUTE ONYX 3.5X30MM", "code_information": [ { "code": "C1874", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 4258.8, "10th_percentile": 4258.8, "90th_percentile": 4420.0, "count": "1 through 10" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1456.46, "10th_percentile": 975.0, "90th_percentile": 4680.0, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1444.95, "10th_percentile": 1444.95, "90th_percentile": 1444.95, "count": "1 through 10" } ] } ] }, { "description": "VAGINAL DELIVERY W STERILIZATION &OR D&C - SOI : 1", "code_information": [ { "code": "5411", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 5815.08, "maximum": 8495.95, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 8495.95 } ] } ] }, { "description": "OTHER SKIN, SUBCUTANEOUS TISSUE & RELATED PROCEDURES - SOI : 4", "code_information": [ { "code": "3644", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 47107.98, "maximum": 49934.45, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 49073.84 } ] } ] }, { "description": "PULMONARY EMBOLISM - SOI : 2", "code_information": [ { "code": "1342", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 9744.01, "maximum": 10328.65, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 10150.63 } ] } ] }, { "description": "RENAL FAILURE WITHOUT CCMCC", "code_information": [ { "code": "684", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 2805.435, "maximum": 16513.2, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 4023.5 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 5755.08 } ] } ] }, { "description": "HEART FAILURE AND SHOCK WITH CC", "code_information": [ { "code": "292", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 4133.5718, "maximum": 22518.0, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 7159.34 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 8139.36 } ] } ] }, { "description": "PT EVAL LOW COMPLEX 20 MIN", "code_information": [ { "code": "97161", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 424.63, "discounted_cash": 80.0, "minimum": 46.335, "maximum": 339.704, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 93.57, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 234.39 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 75.25 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 260.33 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 260.33 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 237.79, "10th_percentile": 202.12, "90th_percentile": 237.79, "count": "1 through 10" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 143.22, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 133.67, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 101.21, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 127.39, "10th_percentile": 127.39, "90th_percentile": 686.69, "count": "14" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 80.68, "10th_percentile": 76.43, "90th_percentile": 90.62, "count": "37" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 157.54, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 100.25, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 100.25, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 24.6, "median_amount": 148.72, "10th_percentile": 119.68, "90th_percentile": 316.04, "count": "11" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 24.6, "median_amount": 158.02, "10th_percentile": 158.02, "90th_percentile": 316.04, "count": "1 through 10" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 157.54, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 95.48, "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": 19.0, "median_amount": 80.68, "10th_percentile": 80.68, "90th_percentile": 80.68, "count": "20" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 95.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 95.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 80.68, "10th_percentile": 76.43, "90th_percentile": 90.62, "count": "14" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 79.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 143.22, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "LYMPHOMA AND NON-ACUTE LEUKEMIA WITHOUT CCMCC", "code_information": [ { "code": "842", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 5058.0954, "maximum": 19515.6, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 7009.69 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 9686.7 } ] } ] }, { "description": "MALFUNCTION, REACTION, COMPLIC OF GENITOURINARY DEVICE OR PROC - SOI : 4", "code_information": [ { "code": "4664", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 20168.94, "maximum": 21379.08, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 21010.61 } ] } ] }, { "description": "HYPERTENSIVE ENCEPHALOPATHY WITH MCC", "code_information": [ { "code": "077", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 14677.9, "maximum": 31525.2, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 14677.9 } ] } ] }, { "description": "INITIAL IMMUNIZATION INJ - 90471 - 004533", "code_information": [ { "code": "90471", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 67.46, "discounted_cash": 12.0, "minimum": 10.119, "maximum": 269.856, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 75.0, "median_amount": 252.99, "10th_percentile": 252.99, "90th_percentile": 252.99, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 28.69, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 67.46 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 52.61 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 67.46 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 67.46 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 188.9, "10th_percentile": 188.9, "90th_percentile": 229.38, "count": "1 through 10" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 43.92, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 40.99, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 31.04, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 64.09, "10th_percentile": 16.27, "90th_percentile": 71.98, "count": "19" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 48.31, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 30.74, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30.74, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 48.31, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 29.28, "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": 24.6, "median_amount": 15.25, "10th_percentile": 15.25, "90th_percentile": 67.46, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 64.09, "10th_percentile": 64.09, "90th_percentile": 64.09, "count": "12" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 29.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 29.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 32.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 43.92, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "NEONATE BIRTHWT >2499G W OTHER SIGNIFICANT CONDITION - SOI : 4", "code_information": [ { "code": "6394", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 44895.21, "maximum": 47588.92, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 46768.73 } ] } ] }, { "description": "STENT RESOLUTE ONYX 4MMX15MM", "code_information": [ { "code": "C1874", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 4258.8, "10th_percentile": 4258.8, "90th_percentile": 4420.0, "count": "1 through 10" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1456.46, "10th_percentile": 975.0, "90th_percentile": 4680.0, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1444.95, "10th_percentile": 1444.95, "90th_percentile": 1444.95, "count": "1 through 10" } ] } ] }, { "description": "OTHER INJURY, POISONING & TOXIC EFFECT DIAGNOSES - SOI : 1", "code_information": [ { "code": "8151", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 5337.57, "maximum": 5657.83, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 5560.32 } ] } ] }, { "description": "CLTX SCAP FX WMNPJ +-TRACTJ", "code_information": [ { "code": "23575", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7500.0, "discounted_cash": 1425.0, "minimum": 640.822, "maximum": 6000.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 640.82, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 1802.67 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 962.33 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 2005.98 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 2005.98 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 980.85, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 915.46, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 693.13, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 2020.41, "10th_percentile": 2020.41, "90th_percentile": 2020.41, "count": "1 through 10" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1078.94, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 686.6, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 686.6, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1078.94, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 653.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 653.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 653.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 980.85, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "DRAINAGE OF GUM LESION", "code_information": [ { "code": "41800", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 568.84, "discounted_cash": 108.0, "minimum": 53.018, "maximum": 455.072, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 53.02, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 145.01 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 77.41 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 161.36 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 161.36 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 81.15, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 75.74, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 57.35, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 89.27, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 56.81, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 56.81, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 89.27, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 54.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 54.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 54.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 81.15, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "EATING DISORDERS - SOI : 1", "code_information": [ { "code": "7591", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 14712.95, "maximum": 15595.72, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 15326.93 } ] } ] }, { "description": "CATH MONORAIL 15MMX3.25", "code_information": [ { "code": "C1725", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 462.76, "10th_percentile": 256.45, "90th_percentile": 2515.23, "count": "21" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 270.69, "10th_percentile": 106.59, "90th_percentile": 1342.29, "count": "14" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 484.0, "10th_percentile": 143.56, "90th_percentile": 543.74, "count": "1 through 10" } ] } ] }, { "description": "CAROTID ARTERY STENT PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "036", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 5400.0, "maximum": 19246.9, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 19246.9 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 18625.62 } ] } ] }, { "description": "SCREW VAL TI 2.4X22MM", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "EYE INFECTIONS AND OTHER EYE DISORDERS - SOI : 3", "code_information": [ { "code": "0823", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 19286.51, "maximum": 20443.7, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 20091.35 } ] } ] }, { "description": "BNE SCREW SELF TAPPING T8 2.7X", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "MANUAL CELL CT EA ERY/LEUK PLT", "code_information": [ { "code": "85032", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 71.88, "discounted_cash": 13.0, "minimum": 3.7497, "maximum": 57.504, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4.22, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.09 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 17.41 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3.75 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.09 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 19.35 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 19.35 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 6.03, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 4.57, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.11, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 4.53, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.45 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.52 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.53, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 7.68 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.09 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.04 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.11, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "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": "fee schedule", "standard_charge_dollar": 5.91 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 4.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 7.04 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "LDH (LD) CSF", "code_information": [ { "code": "83615", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 132.5, "discounted_cash": 25.0, "minimum": 4.983, "maximum": 116.6, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5.92, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.52 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 24.4 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5.25 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.52 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 27.12 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 27.12 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 81.62, "10th_percentile": 81.62, "90th_percentile": 99.11, "count": "1 through 10" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.06, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 8.46, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 6.4, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 26.24, "10th_percentile": 26.24, "90th_percentile": 27.69, "count": "1 through 10" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9.97, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 6.34, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.03 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.92 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.34, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 10.75 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.52 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.25 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.97, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 6.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.27 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 27.69, "10th_percentile": 27.69, "90th_percentile": 27.69, "count": "1 through 10" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 6.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 26.24, "10th_percentile": 26.24, "90th_percentile": 26.24, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 9.88 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9.06, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "CORDARONE", "drug_information": { "unit": 3.0, "type": "ML" }, "code_information": [ { "code": "63323061603", "type": "NDC" }, { "code": "J0282", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 50.16, "10th_percentile": 2.58, "90th_percentile": 153.77, "count": "1 through 10" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 24.6, "median_amount": 10.61, "10th_percentile": 10.61, "90th_percentile": 10.61, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 50.16, "10th_percentile": 2.58, "90th_percentile": 134.32, "count": "1 through 10" } ] } ] }, { "description": "CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITH CC", "code_information": [ { "code": "309", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 3460.7292, "maximum": 17263.8, "payers_information": [ { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "other", "standard_charge_dollar": 10350.0, "standard_charge_algorithm": "$4,500 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 4500.0, "10th_percentile": 4500.0, "90th_percentile": 4500.0, "count": "1 through 10" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 4540.01 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 7053.16 } ] } ] }, { "description": "ANCA by IFA", "code_information": [ { "code": "86038", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 137.5, "discounted_cash": 12.0, "minimum": 1.8135, "maximum": 209.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.06 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 48.84 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 10.52 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.06 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 54.28 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 54.28 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 37.24, "10th_percentile": 37.24, "90th_percentile": 45.22, "count": "1 through 10" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.14, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 16.93, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 12.82, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 12.64, "10th_percentile": 3.01, "90th_percentile": 12.64, "count": "1 through 10" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.95, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.69, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.08 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.87 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.69, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 21.53 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.06 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.52 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.95, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "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": "fee schedule", "standard_charge_dollar": 16.56 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 12.64, "10th_percentile": 12.64, "90th_percentile": 12.64, "count": "1 through 10" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 19.79 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.14, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "HUMERAL STEM CEMENTLESS - C1776 - 050925", "code_information": [ { "code": "C1776", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 4588.1, "10th_percentile": 1617.12, "90th_percentile": 11630.3, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 9120.0, "10th_percentile": 9120.0, "90th_percentile": 9120.0, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 8640.0, "10th_percentile": 8640.0, "90th_percentile": 9120.0, "count": "1 through 10" } ] } ] }, { "description": "CANC SCREW 2333-30", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "PATHOLOGICAL FRACTURES AND MUSCULOSKELETAL AND CONNECTIVE TISSUE MALIGNANCY WITH MCC", "code_information": [ { "code": "542", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 8336.8754, "maximum": 39031.2, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 23989.6 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 16935.44 } ] } ] }, { "description": "IPACK BLOCK(UNLISTED PRCDR)", "code_information": [ { "code": "64999", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1223.5, "discounted_cash": 232.0, "minimum": 122.3334, "maximum": 978.8, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 122.33, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 348.15 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 185.86 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 387.42 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 387.42 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 187.25, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 174.76, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 132.32, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 205.97, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 131.07, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.07, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 205.97, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 124.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 124.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 124.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 187.25, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "TREAT HUMERUS FRACTURE - 24505 - 964664", "code_information": [ { "code": "24505", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7112.55, "discounted_cash": 1351.0, "minimum": 640.822, "maximum": 5690.04, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 640.82, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 1802.67 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 962.33 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 2005.98 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 2005.98 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 980.85, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 915.46, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 693.13, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1078.94, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 686.6, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 686.6, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1078.94, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 653.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 653.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 653.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 980.85, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "HNK1 (CD57) Profile", "code_information": [ { "code": "86356", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 340.05, "discounted_cash": 64.0, "minimum": 23.2986, "maximum": 272.04, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 26.24, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 37.79 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 108.19 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 23.3 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 37.79 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 120.24 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 120.24 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 40.17, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 37.49, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 28.39, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 44.19, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 28.12, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 40.06 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 52.89 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.12, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 47.7 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 37.79 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 49.9 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 44.19, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "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": "fee schedule", "standard_charge_dollar": 36.69 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 26.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 26.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 43.84 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.17, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "2.4MX18MM CORTEX SCREW", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "INSIGNIA ULTRA SSSIRO IS", "code_information": [ { "code": "C1786", "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": 19.0, "median_amount": 4220.28, "10th_percentile": 4220.28, "90th_percentile": 4220.28, "count": "1 through 10" } ] } ] }, { "description": "CATH QUANTUM 12MM X 4.0M", "code_information": [ { "code": "C1725", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 462.76, "10th_percentile": 256.45, "90th_percentile": 2515.23, "count": "21" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 270.69, "10th_percentile": 106.59, "90th_percentile": 1342.29, "count": "14" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 484.0, "10th_percentile": 143.56, "90th_percentile": 543.74, "count": "1 through 10" } ] } ] }, { "description": "HAND & WRIST PROCEDURES - SOI : 3", "code_information": [ { "code": "3163", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 18689.62, "maximum": 19811.0, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 19469.56 } ] } ] }, { "description": "GUIDEWIRE .038 630-1", "code_information": [ { "code": "C1769", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 228.66, "10th_percentile": 43.17, "90th_percentile": 1333.19, "count": "49" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 200.16, "10th_percentile": 45.57, "90th_percentile": 746.52, "count": "29" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 130.22, "10th_percentile": 39.18, "90th_percentile": 442.41, "count": "15" } ] } ] }, { "description": "STREP A DNA AMP PROBE - 87651 - 800466", "code_information": [ { "code": "87651", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 256.74, "discounted_cash": 48.0, "minimum": 30.5283, "maximum": 205.392, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 34.39, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 49.51 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 141.76 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 30.53 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 49.51 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 157.55 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 157.55 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 52.64, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 49.13, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 37.2, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 57.9, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 36.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 52.48 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 69.3 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 62.49 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 49.51 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 65.38 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 57.9, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 48.07 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 57.44 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 52.64, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "THIAMINE HCL", "drug_information": { "unit": 1.0, "type": "ML" }, "code_information": [ { "code": "63323001302", "type": "NDC" }, { "code": "J3411", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 27.09, "10th_percentile": 27.09, "90th_percentile": 27.09, "count": "1 through 10" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 7.57, "10th_percentile": 7.17, "90th_percentile": 17.0, "count": "11" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 7.57, "10th_percentile": 7.57, "90th_percentile": 7.57, "count": "1 through 10" } ] } ] }, { "description": "LOVENOX - 00075062280", "drug_information": { "unit": 0.8, "type": "ML" }, "code_information": [ { "code": "00075062280", "type": "NDC" }, { "code": "J1650", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 53.96, "10th_percentile": 44.44, "90th_percentile": 53.96, "count": "1 through 10" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 15.08, "10th_percentile": 12.7, "90th_percentile": 33.92, "count": "61" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 24.6, "median_amount": 6.31, "10th_percentile": 2.31, "90th_percentile": 15.78, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 15.08, "10th_percentile": 15.08, "90th_percentile": 30.2, "count": "34" } ] } ] }, { "description": "PLATE 3 HOLE RIGHT", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "ANTI-GBM ANTIBODIES", "code_information": [ { "code": "83516", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 297.25, "discounted_cash": 32.0, "minimum": 4.4625, "maximum": 436.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11.3, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.26 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 46.58 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 10.03 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.26 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 51.77 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 51.77 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 94.5, "10th_percentile": 94.5, "90th_percentile": 114.75, "count": "1 through 10" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17.3, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 16.14, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 12.22, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 30.38, "10th_percentile": 5.36, "90th_percentile": 96.03, "count": "1 through 10" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.02, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.24 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.76 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 20.53 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.26 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.47 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.02, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "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": "fee schedule", "standard_charge_dollar": 15.79 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 5.65, "10th_percentile": 5.65, "90th_percentile": 5.65, "count": "1 through 10" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 18.89 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.3, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "DOG EPITHELIA", "code_information": [ { "code": "86003", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 52.51, "discounted_cash": 3.0, "minimum": 2.445, "maximum": 352.08, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5.12, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.36 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 21.09 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 4.54 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.36 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 23.44 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 23.44 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 37.06, "10th_percentile": 37.06, "90th_percentile": 222.36, "count": "1 through 10" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7.83, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 7.31, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 5.53, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.61, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.81 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.31 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 9.3 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.36 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.72 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.61, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "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": "fee schedule", "standard_charge_dollar": 7.15 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 10.36, "10th_percentile": 10.36, "90th_percentile": 10.36, "count": "1 through 10" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 8.54 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.83, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "DHEA SULFATE LC", "code_information": [ { "code": "82627", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 25.0, "discounted_cash": 4.0, "minimum": 3.75, "maximum": 25.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 21.79, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.0 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 25.0 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 19.34 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.0 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 25.0 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 25.0 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 17.0, "10th_percentile": 17.0, "90th_percentile": 17.0, "count": "1 through 10" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 25.0, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 25.0, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 23.56, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 25.0, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 23.34, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.0 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.0 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.34, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 25.0 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.0 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.0 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 25.0, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "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": "fee schedule", "standard_charge_dollar": 25.0 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 22.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 22.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 25.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 25.0, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "OTHER MALE REPRODUCTIVE SYSTEM & RELATED PROCEDURES - SOI : 4", "code_information": [ { "code": "4844", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 60594.68, "maximum": 64230.36, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 63123.36 } ] } ] }, { "description": "MENSTRUAL & OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS - SOI : 1", "code_information": [ { "code": "5321", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 5186.68, "maximum": 5497.88, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 5403.13 } ] } ] }, { "description": "CATH VIANCE FLEXIBLE 150CM - C1725 - 900387", "code_information": [ { "code": "C1725", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 462.76, "10th_percentile": 256.45, "90th_percentile": 2515.23, "count": "21" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 270.69, "10th_percentile": 106.59, "90th_percentile": 1342.29, "count": "14" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 484.0, "10th_percentile": 143.56, "90th_percentile": 543.74, "count": "1 through 10" } ] } ] }, { "description": "RADIOTHERAPY", "code_information": [ { "code": "849", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 11487.275, "maximum": 55544.4, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 25354.4 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 25975.98 } ] } ] }, { "description": "NEONATE, TRANSFERRED < 5 DAYS OLD, BORN HERE - SOI : 2", "code_information": [ { "code": "5812", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 2525.06, "maximum": 2676.56, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 2630.43 } ] } ] }, { "description": "DES BYPASS GRAFT INITIAL", "code_information": [ { "code": "C9604", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 31531.4, "minimum": 4600.6786, "maximum": 25225.12, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4600.68, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 16348.99 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 7035.02 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 18132.52 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 18132.52 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7041.86, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 6572.4, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 4976.24, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7746.04, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 4929.3, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4929.3, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7746.04, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 4694.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4694.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 4694.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7041.86, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "HAPTOGLOBIN QUANT", "code_information": [ { "code": "83010", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 69.19, "discounted_cash": 13.0, "minimum": 10.3785, "maximum": 56.48, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12.33, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.76 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 50.82 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 10.94 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.76 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 56.48 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 56.48 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.87, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 17.61, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 13.33, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 20.76, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 13.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.82 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.85 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 22.41 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.76 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.45 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.76, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.24 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 13.15, "10th_percentile": 13.15, "90th_percentile": 13.15, "count": "1 through 10" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 12.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 12.45, "10th_percentile": 12.45, "90th_percentile": 12.45, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 20.59 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.87, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "EXTENSIVE 3RD DEGREE BURNS W SKIN GRAFT - SOI : 2", "code_information": [ { "code": "8412", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 68400.97, "maximum": 72505.03, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 71255.41 } ] } ] }, { "description": "ALLERGIC REACTIONS - SOI : 3", "code_information": [ { "code": "8113", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 12471.53, "maximum": 13219.82, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 12991.98 } ] } ] }, { "description": "ALLERGY PROFILE W/TOTAL IGE", "code_information": [ { "code": "82785", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 148.35, "discounted_cash": 35.0, "minimum": 14.3202, "maximum": 148.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 16.13, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.23 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 66.5 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 14.32 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.23 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 73.91 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 73.91 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.69, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 23.04, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 17.45, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 27.16, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 17.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.62 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 32.51 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 29.32 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.23 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.67 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 27.16, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 16.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.55 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 16.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 26.96 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 24.69, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "PATH STAIN GROUP 1", "code_information": [ { "code": "88312", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 182.0, "discounted_cash": 38.0, "minimum": 20.7662, "maximum": 200.2, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 20.77, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 182.0 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 43.04 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 182.0 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 182.0 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 31.79, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 29.67, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 22.46, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 34.96, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 22.25, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.25, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 34.96, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 21.19, "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": 19.0, "median_amount": 34.58, "10th_percentile": 34.58, "90th_percentile": 34.58, "count": "1 through 10" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 21.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 21.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 23.81 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 31.79, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "Revise ulnar nerve at wrist", "code_information": [ { "code": "64719", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2651.25, "discounted_cash": 503.0, "minimum": 397.6875, "maximum": 2544.64, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 778.21, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 2286.74 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 1220.74 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 2544.64 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 2544.64 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1191.14, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 1111.73, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 841.74, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1310.25, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 833.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 833.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1310.25, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 794.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 794.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 794.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1191.14, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "ANTINUCLEAR AB IFA LC", "code_information": [ { "code": "86038", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 14.1, "discounted_cash": 12.0, "minimum": 1.8135, "maximum": 209.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.1 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 14.1 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 10.52 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.1 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 14.1 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 14.1 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 161.5, "10th_percentile": 146.3, "90th_percentile": 177.65, "count": "1 through 10" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14.1, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 14.1, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 12.82, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 47.03, "10th_percentile": 12.09, "90th_percentile": 50.68, "count": "1 through 10" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.1, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.69, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.1 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.1 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.69, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 14.1 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.1 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.1 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.1, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "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": "fee schedule", "standard_charge_dollar": 14.1 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 2.68, "10th_percentile": 2.68, "90th_percentile": 49.64, "count": "1 through 10" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 14.1 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.1, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "OSTEOMYELITIS, SEPTIC ARTHRITIS & OTHER MUSCULOSKELETAL INFECTIONS - SOI : 1", "code_information": [ { "code": "3441", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 8948.48, "maximum": 9485.39, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 9321.91 } ] } ] }, { "description": "PROCEDURE W DIAG OF REHAB, AFTERCARE OR OTH CONTACT W HEALTH SERVICE - SOI : 2", "code_information": [ { "code": "8502", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 32438.01, "maximum": 34384.29, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 33791.67 } ] } ] }, { "description": "NEONATE BWT 2000-2499G W RESP DIST SYNDOTH MAJ RESP COND - SOI : 2", "code_information": [ { "code": "6222", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 23361.55, "maximum": 24763.25, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 24336.45 } ] } ] }, { "description": "Treat humerus fracture - 24516 - OR36024516", "code_information": [ { "code": "24516", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8837.5, "discounted_cash": 1679.0, "minimum": 1325.625, "maximum": 8837.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5116.57, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 8837.5 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 8449.5 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 8837.5 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 8837.5 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7831.49, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 7309.39, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 5534.25, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8614.63, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5482.04, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5482.04, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8614.63, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5220.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5220.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 5220.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7831.49, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "EPISTAXIS WITH MCC", "code_information": [ { "code": "150", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 6117.4646, "maximum": 27021.6, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 13119.8 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 12765.09 } ] } ] }, { "description": "ACUTE & SUBACUTE ENDOCARDITIS - SOI : 1", "code_information": [ { "code": "1931", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 20248.21, "maximum": 21463.1, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 21093.18 } ] } ] }, { "description": "INTMD RPR N HF/GENIT 12.6-20", "code_information": [ { "code": "12045", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2992.0, "discounted_cash": 568.0, "minimum": 294.539, "maximum": 2393.6, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 294.54, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 661.04 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 352.88 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 735.59 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 735.59 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 450.83, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 420.77, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 318.58, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 495.91, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 315.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 315.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 495.91, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 300.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 300.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 300.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 450.83, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "ACUTE BRONCHITIS AND RELATED SYMPTOMS - SOI : 3", "code_information": [ { "code": "1453", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 11918.57, "maximum": 12633.69, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 12415.95 } ] } ] }, { "description": "PERCLOSE CLOSURE DEVICE", "code_information": [ { "code": "C1760", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 1856.4, "10th_percentile": 1856.4, "90th_percentile": 1856.4, "count": "1 through 10" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 570.57, "10th_percentile": 513.23, "90th_percentile": 975.65, "count": "28" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 555.75, "10th_percentile": 518.7, "90th_percentile": 1012.7, "count": "23" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 526.5, "10th_percentile": 513.23, "90th_percentile": 1089.27, "count": "11" } ] } ] }, { "description": "3.5X12MM CORTICAL SCREW", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "CMPLX RPR S/A/L 2.6-7.5 CM - 13121 - 007080", "code_information": [ { "code": "13121", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2254.41, "discounted_cash": 428.0, "minimum": 162.0038, "maximum": 4949.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 162.0, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 661.04 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 352.88 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 735.59 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 735.59 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 247.97, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 231.43, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 175.23, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 272.76, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 173.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 272.76, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 165.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 165.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 165.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 247.97, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "SCREW BNE ST LCKNG 3.5X44MM", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "MRI TMJ", "code_information": [ { "code": "70336", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4018.15, "discounted_cash": 763.0, "minimum": 95.0796, "maximum": 3214.52, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 95.08, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 303.0 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 941.48 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 202.74 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 303.0 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1046.35 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 1046.35 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 145.53, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 135.83, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 102.84, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 160.08, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 101.87, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 321.17 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 424.08 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 101.87, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 382.42 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 303.0 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 400.07 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 160.08, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 97.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 294.17 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 97.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 97.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 353.74 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 145.53, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "MULTIPLE SIGNIFICANT TRAUMA WO O.R. PROCEDURE - SOI : 4", "code_information": [ { "code": "9304", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 48242.53, "maximum": 51137.08, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 50255.74 } ] } ] }, { "description": "HUMERAL HEAD 18MM X 44MM", "code_information": [ { "code": "C1776", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 4588.1, "10th_percentile": 1617.12, "90th_percentile": 11630.3, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 9120.0, "10th_percentile": 9120.0, "90th_percentile": 9120.0, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 8640.0, "10th_percentile": 8640.0, "90th_percentile": 9120.0, "count": "1 through 10" } ] } ] }, { "description": "WIC SILVER ROPE 1CMX35CM", "code_information": [ { "code": "A4649", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 10.66, "10th_percentile": 3.56, "90th_percentile": 309.79, "count": "12" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 9.49, "10th_percentile": 3.56, "90th_percentile": 336.36, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 9.49, "10th_percentile": 8.78, "90th_percentile": 73.99, "count": "1 through 10" } ] } ] }, { "description": "MESH VENTRALIGHT WITH ECHO 8ö", "code_information": [ { "code": "C1781", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1862.28, "10th_percentile": 1862.28, "90th_percentile": 11852.02, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1206.78, "10th_percentile": 1206.78, "90th_percentile": 1206.78, "count": "1 through 10" } ] } ] }, { "description": "UNCOMPLICATED PEPTIC ULCER WITH MCC", "code_information": [ { "code": "383", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 6053.7362, "maximum": 28522.8, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 12000.4 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 13236.77 } ] } ] }, { "description": "NONSPECIFIC CVA AND PRECEREBRAL OCCLUSION WITHOUT INFARCTION WITH MCC", "code_information": [ { "code": "067", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 13809.9, "maximum": 24769.8, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 13809.9 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 14080.43 } ] } ] }, { "description": "CIRRHOSIS AND ALCOHOLIC HEPATITIS WITH MCC", "code_information": [ { "code": "432", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 8691.5378, "maximum": 36779.4, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 16940.6 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 18869.13 } ] } ] }, { "description": "TRANSURETHRAL PROSTATECTOMY - SOI : 2", "code_information": [ { "code": "4822", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 12024.58, "maximum": 12746.06, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 12526.38 } ] } ] }, { "description": "RENAL DIALYSIS ACCESS DEVICE PROCEDURES- SOI : 4", "code_information": [ { "code": "4444", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 54590.51, "maximum": 57865.94, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 56868.62 } ] } ] }, { "description": "SCREW SLF TPNG 2.4MMX36MM", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "MESH 3D MAX LEFT 10.8X16 CM", "code_information": [ { "code": "C1781", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1862.28, "10th_percentile": 1862.28, "90th_percentile": 11852.02, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1206.78, "10th_percentile": 1206.78, "90th_percentile": 1206.78, "count": "1 through 10" } ] } ] }, { "description": "CORONARY BYPASS W AMI OR COMPLEX PDX - SOI : 4", "code_information": [ { "code": "1654", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 93052.74, "maximum": 98635.91, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 96935.92 } ] } ] }, { "description": "PERCUTANEOUS CORONARY INTERVENTION W AMI - SOI : 4", "code_information": [ { "code": "1744", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 46739.34, "maximum": 49543.7, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 48689.82 } ] } ] }, { "description": "VANCOMYCIN PEAK", "code_information": [ { "code": "80202", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 246.88, "discounted_cash": 46.0, "minimum": 10.155, "maximum": 217.256, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13.27, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.11 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 54.7 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 11.78 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.11 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 60.79 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 60.79 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 152.08, "10th_percentile": 152.08, "90th_percentile": 152.08, "count": "1 through 10" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 20.31, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 18.96, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 14.35, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 13.54, "10th_percentile": 13.54, "90th_percentile": 57.95, "count": "1 through 10" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 22.34, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 14.22, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.25 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26.74 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.22, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 24.12 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.11 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.23 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 22.34, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "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": "fee schedule", "standard_charge_dollar": 18.55 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 13.54, "10th_percentile": 13.54, "90th_percentile": 51.6, "count": "1 through 10" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 13.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 48.88, "10th_percentile": 48.88, "90th_percentile": 51.6, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 22.19 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 20.31, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "GUIDING CATH XBLAD 3.5 6", "code_information": [ { "code": "C1887", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 115.24, "10th_percentile": 81.0, "90th_percentile": 503.66, "count": "23" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 156.51, "10th_percentile": 102.6, "90th_percentile": 572.45, "count": "11" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 129.36, "10th_percentile": 24.35, "90th_percentile": 512.12, "count": "1 through 10" } ] } ] }, { "description": "EX-FIN PIN CLAMP 6 POSITION", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "PERM CARDIAC PACEMAKER IMPLANT WO AMI, HEART FAILURE OR SHOCK - SOI : 3", "code_information": [ { "code": "1713", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 28252.18, "maximum": 29947.31, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 29431.17 } ] } ] }, { "description": "STENT CORONARY L28OD2.75", "code_information": [ { "code": "C1874", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 4258.8, "10th_percentile": 4258.8, "90th_percentile": 4420.0, "count": "1 through 10" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1456.46, "10th_percentile": 975.0, "90th_percentile": 4680.0, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1444.95, "10th_percentile": 1444.95, "90th_percentile": 1444.95, "count": "1 through 10" } ] } ] }, { "description": "HEMORRHAGE OR HEMATOMA DUE TO COMPLICATION - SOI : 4", "code_information": [ { "code": "8104", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 61156.23, "maximum": 64825.61, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 63708.34 } ] } ] }, { "description": "PRELONE", "drug_information": { "unit": 5.0, "type": "ML" }, "code_information": [ { "code": "50383004224", "type": "NDC" }, { "code": "J7510", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 13.11, "10th_percentile": 10.8, "90th_percentile": 26.22, "count": "1 through 10" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 4.11, "10th_percentile": 4.11, "90th_percentile": 4.11, "count": "1 through 10" } ] } ] }, { "description": "SEPTICEMIA & DISSEMINATED INFECTIONS - SOI : 4", "code_information": [ { "code": "7204", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 35790.1, "maximum": 37937.51, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 37283.66 } ] } ] }, { "description": "SURGIMESH PLUG TEALFIL-8", "code_information": [ { "code": "C1781", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1862.28, "10th_percentile": 1862.28, "90th_percentile": 11852.02, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1206.78, "10th_percentile": 1206.78, "90th_percentile": 1206.78, "count": "1 through 10" } ] } ] }, { "description": "VIRAL ILLNESS - SOI : 4", "code_information": [ { "code": "7234", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 73651.63, "maximum": 78070.73, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 76725.19 } ] } ] }, { "description": "FRACTURE OF PELVIS OR DISLOCATION OF HIP - SOI : 2", "code_information": [ { "code": "3412", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 10044.84, "maximum": 10647.53, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 10464.02 } ] } ] }, { "description": "Exc snhfg mal+mrg 2.1-3", "code_information": [ { "code": "11623", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2651.25, "discounted_cash": 503.0, "minimum": 128.63, "maximum": 2121.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 658.2, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 173.92 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 128.63 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 193.85 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 193.85 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1007.45, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 940.28, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 711.93, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1108.19, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 705.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 705.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1108.19, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 671.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 671.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 671.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1007.45, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "ACTIVE WOUND CARE>20 CM", "code_information": [ { "code": "97598", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 760.0, "discounted_cash": 79.0, "minimum": 10.0311, "maximum": 608.0, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 31.25 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 10.03 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 34.71 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 34.71 } ] } ] }, { "description": "GUIDE CATHETER 6 FRE EBU 3.75", "code_information": [ { "code": "C1887", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 115.24, "10th_percentile": 81.0, "90th_percentile": 503.66, "count": "23" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 156.51, "10th_percentile": 102.6, "90th_percentile": 572.45, "count": "11" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 129.36, "10th_percentile": 24.35, "90th_percentile": 512.12, "count": "1 through 10" } ] } ] }, { "description": "CATH NC EUPHORA 2.5X12MM", "code_information": [ { "code": "C1725", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 462.76, "10th_percentile": 256.45, "90th_percentile": 2515.23, "count": "21" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 270.69, "10th_percentile": 106.59, "90th_percentile": 1342.29, "count": "14" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 484.0, "10th_percentile": 143.56, "90th_percentile": 543.74, "count": "1 through 10" } ] } ] }, { "description": "Egd place gastrostomy tube - 43246 - OR36043246", "code_information": [ { "code": "43246", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1767.5, "discounted_cash": 335.0, "minimum": 265.125, "maximum": 3393.024, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 764.73, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 1767.5 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 1105.75 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 1767.5 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 1767.5 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1170.51, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 1092.48, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 827.16, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1287.56, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 819.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 819.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1287.56, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 780.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 780.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 780.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1170.51, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "FACTOR II ACTIVITY", "code_information": [ { "code": "85210", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 75.0, "discounted_cash": 14.0, "minimum": 11.25, "maximum": 60.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12.72, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.31 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 52.44 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 11.29 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.31 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 58.28 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 58.28 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.47, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 18.17, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 13.76, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.42, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 13.63, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.41 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.63 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.63, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 23.11 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.31 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.18 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.42, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.78 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 12.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 21.26 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.47, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "NANOCROSS ELITE BLN 5X60MM", "code_information": [ { "code": "C1725", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 462.76, "10th_percentile": 256.45, "90th_percentile": 2515.23, "count": "21" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 270.69, "10th_percentile": 106.59, "90th_percentile": 1342.29, "count": "14" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 484.0, "10th_percentile": 143.56, "90th_percentile": 543.74, "count": "1 through 10" } ] } ] }, { "description": "HICKMAN CATHETER 12FR DL", "code_information": [ { "code": "C1751", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 298.58, "10th_percentile": 298.58, "90th_percentile": 298.58, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 298.58, "10th_percentile": 298.58, "90th_percentile": 298.58, "count": "1 through 10" } ] } ] }, { "description": "HANDLE W/ Q CONNECT", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "CATH 4FR INFINITY JL 3.5", "code_information": [ { "code": "C1887", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 115.24, "10th_percentile": 81.0, "90th_percentile": 503.66, "count": "23" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 156.51, "10th_percentile": 102.6, "90th_percentile": 572.45, "count": "11" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 129.36, "10th_percentile": 24.35, "90th_percentile": 512.12, "count": "1 through 10" } ] } ] }, { "description": "TX/PROPH/DG ADDL SEQ IV INF-ER", "code_information": [ { "code": "96367", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 337.32, "discounted_cash": 50.0, "minimum": 27.5877, "maximum": 3535.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 28.69, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 85.93 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 27.59 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 95.45 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 95.45 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 43.92, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 40.99, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 31.04, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 71.98, "10th_percentile": 48.91, "90th_percentile": 337.32, "count": "1 through 10" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 48.31, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 30.74, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30.74, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 48.31, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 29.28, "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": 19.0, "median_amount": 64.09, "10th_percentile": 64.09, "90th_percentile": 64.09, "count": "1 through 10" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 29.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 29.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 70.87, "10th_percentile": 60.72, "90th_percentile": 71.98, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 43.92, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "VERTIGO & OTHER LABYRINTH DISORDERS - SOI : 4", "code_information": [ { "code": "1114", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 16346.02, "maximum": 17326.78, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 17028.15 } ] } ] }, { "description": "Lumbarcool 1st Level Rhizotomy", "code_information": [ { "code": "64635", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4387.84, "discounted_cash": 833.0, "minimum": 658.176, "maximum": 3510.272, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 778.21, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 2286.74 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 1220.74 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 2544.64 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 2544.64 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1191.14, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 1111.73, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 841.74, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1310.25, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 833.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 833.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1310.25, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 794.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 794.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 794.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1191.14, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "REHABILITATION - SOI : 4", "code_information": [ { "code": "8604", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 26703.15, "maximum": 28305.34, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 27817.49 } ] } ] }, { "description": "CATH RUNWAY 6FR JL4", "code_information": [ { "code": "C1887", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 115.24, "10th_percentile": 81.0, "90th_percentile": 503.66, "count": "23" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 156.51, "10th_percentile": 102.6, "90th_percentile": 572.45, "count": "11" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 129.36, "10th_percentile": 24.35, "90th_percentile": 512.12, "count": "1 through 10" } ] } ] }, { "description": "OTHER DISORDERS OF THE LIVER - SOI : 4", "code_information": [ { "code": "2834", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 46682.04, "maximum": 49482.96, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 48630.13 } ] } ] }, { "description": "CATHETER NANOCROSS ELITE5.0X80", "code_information": [ { "code": "C1725", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 462.76, "10th_percentile": 256.45, "90th_percentile": 2515.23, "count": "21" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 270.69, "10th_percentile": 106.59, "90th_percentile": 1342.29, "count": "14" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 484.0, "10th_percentile": 143.56, "90th_percentile": 543.74, "count": "1 through 10" } ] } ] }, { "description": "THEOPHYLLINE QUANT(REF)", "code_information": [ { "code": "80198", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 50.0, "discounted_cash": 9.0, "minimum": 7.5, "maximum": 50.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13.86, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.95 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 50.0 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.3 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.95 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 50.0 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 50.0 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 21.21, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 19.8, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 14.99, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 23.33, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 14.85, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.15 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.92 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.85, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 25.18 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.95 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26.34 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 23.33, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 14.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.37 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 14.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 23.16 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.21, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "US BREAST LOCALIZATION DEVICE", "code_information": [ { "code": "19285", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 672.0, "discounted_cash": 127.0, "minimum": 100.8, "maximum": 672.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 282.2, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 672.0 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 433.11 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 672.0 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 672.0 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 431.94, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 403.14, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 305.24, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 475.13, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 302.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 302.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 475.13, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 287.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 287.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 287.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 431.94, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "ALK PHOS ISOENZYMES", "code_information": [ { "code": "84080", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 168.75, "discounted_cash": 23.0, "minimum": 12.8586, "maximum": 135.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14.48, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.86 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 59.71 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.86 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.86 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 66.36 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 66.36 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 114.75, "10th_percentile": 114.75, "90th_percentile": 114.75, "count": "1 through 10" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.17, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 20.69, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 15.67, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 24.39, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 15.52, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.11 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 29.19 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.52, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 26.33 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.86 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.54 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 24.39, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.25 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 24.2 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 22.17, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "GAD-65(REF)", "code_information": [ { "code": "86341", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 183.25, "discounted_cash": 52.0, "minimum": 20.5059, "maximum": 328.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 23.1, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 33.26 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 95.22 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 20.51 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 33.26 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 105.83 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 105.83 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 35.36, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 33.0, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 24.98, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 38.89, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 24.75, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 35.25 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 46.55 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.75, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 41.98 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 33.26 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 43.91 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 38.89, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "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": "fee schedule", "standard_charge_dollar": 32.29 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 23.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 23.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 32.39 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 35.36, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "GAMMA NAIL RIGHT 340MM", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "XR RIBS UNI W/CXR 3+V-RT", "code_information": [ { "code": "71101", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 695.29, "discounted_cash": 132.0, "minimum": 41.6598, "maximum": 556.232, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 41.66, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 135.95 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 452.8 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 97.51 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 135.95 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 503.24 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 503.24 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 389.36, "10th_percentile": 389.36, "90th_percentile": 429.81, "count": "1 through 10" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 63.77, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 59.51, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 45.06, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 340.22, "10th_percentile": 340.22, "90th_percentile": 1165.22, "count": "1 through 10" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 134.89, "10th_percentile": 125.15, "90th_percentile": 148.38, "count": "1 through 10" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 70.14, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 44.64, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 144.11 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 190.28 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 44.64, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "QTC Medical Group", "plan_name": "QTC Medical Group", "methodology": "fee schedule", "standard_charge_dollar": 97.59 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 171.59 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 135.95 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 179.51 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 70.14, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 42.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 131.99 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 132.11, "10th_percentile": 132.11, "90th_percentile": 132.11, "count": "1 through 10" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 42.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 42.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 109.07 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 63.77, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "SCRW BNE TI LCKNG 4.0X34MM", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "EXTENSIVE THIRD DEGREE BURNS WITHOUT SKIN GRAFT- SOI : 2", "code_information": [ { "code": "8432", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 13501.03, "maximum": 14311.09, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 14064.44 } ] } ] }, { "description": "FOLATE (FOLIC ACID)", "code_information": [ { "code": "82746", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 203.5, "discounted_cash": 38.0, "minimum": 12.789, "maximum": 162.8, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14.41, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.74 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 59.39 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.79 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.74 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 66.0 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 66.0 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 113.96, "10th_percentile": 113.96, "90th_percentile": 138.38, "count": "1 through 10" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.05, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 20.58, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 15.58, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 36.63, "10th_percentile": 14.7, "90th_percentile": 43.43, "count": "14" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 24.26, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 15.44, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.99 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 29.03 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.44, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 26.18 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.74 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.39 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 24.26, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "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": "fee schedule", "standard_charge_dollar": 20.14 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 38.67, "10th_percentile": 14.7, "90th_percentile": 38.67, "count": "22" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 14.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 43.43, "10th_percentile": 36.63, "90th_percentile": 43.43, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 24.07 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 22.05, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "OTHER MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE PROCEDURES - SOI : 4", "code_information": [ { "code": "3204", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 49447.76, "maximum": 52414.63, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 51511.26 } ] } ] }, { "description": "BIOMONITOR LOOP RECORDER", "code_information": [ { "code": "C1764", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 7650.0, "10th_percentile": 6480.0, "90th_percentile": 8075.0, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 7650.0, "10th_percentile": 7650.0, "90th_percentile": 7650.0, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 7682.4, "10th_percentile": 7682.4, "90th_percentile": 7682.4, "count": "1 through 10" } ] } ] }, { "description": "ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH CC", "code_information": [ { "code": "281", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 4304.4378, "maximum": 18014.4, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 8782.43 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 8811.41 } ] } ] }, { "description": "AUTOLOGOUS BONE MARROW TRANSPLANT OR T-CELL IMMUNOTHERAPY- SOI : 4", "code_information": [ { "code": "0084", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 210800.24, "maximum": 223448.25, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 219597.14 } ] } ] }, { "description": "FINELINE 52CM BIOPOLAR", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "MAJOR ESOPHAGEAL DISORDERS - SOI : 3", "code_information": [ { "code": "2423", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 14288.92, "maximum": 15146.25, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 14885.21 } ] } ] }, { "description": "VAGINAL DELIVERY - SOI : 4", "code_information": [ { "code": "5604", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 9536.77, "maximum": 13933.42, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 13933.42 } ] } ] }, { "description": "STEINMAN PIN 7/64", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 168.56, "10th_percentile": 168.56, "90th_percentile": 168.56, "count": "1 through 10" } ] } ] }, { "description": "AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITH CC", "code_information": [ { "code": "475", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 10130.0448, "maximum": 42784.2, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 17880.4 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 21817.14 } ] } ] }, { "description": "ALCOHOL BREATH INITIAL", "code_information": [ { "code": "82075", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 107.05, "discounted_cash": 20.0, "minimum": 16.0575, "maximum": 107.05, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 29.4, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 42.33 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 107.05 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 26.1 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 42.33 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 107.05 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 107.05 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 45.0, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 42.0, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 31.8, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 49.5, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 31.5, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 44.87 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 59.25 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 31.5, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 53.43 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 42.33 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 55.9 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 49.5, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 30.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 41.1 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 30.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 30.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 19.73 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 45.0, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "2.7MM COREX SCREW", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "STENT XIENCE SIERRA 3.5X15MM - C1874 - 901241", "code_information": [ { "code": "C1874", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 4258.8, "10th_percentile": 4258.8, "90th_percentile": 4420.0, "count": "1 through 10" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1456.46, "10th_percentile": 975.0, "90th_percentile": 4680.0, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1444.95, "10th_percentile": 1444.95, "90th_percentile": 1444.95, "count": "1 through 10" } ] } ] }, { "description": "PLATE CONTOUR 109 MM 3.5MM 3H", "code_information": [ { "code": "C1776", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 4588.1, "10th_percentile": 1617.12, "90th_percentile": 11630.3, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 9120.0, "10th_percentile": 9120.0, "90th_percentile": 9120.0, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 8640.0, "10th_percentile": 8640.0, "90th_percentile": 9120.0, "count": "1 through 10" } ] } ] }, { "description": "OTHER MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES FOR MALIGNANCY WITH CCMCC", "code_information": [ { "code": "715", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 9323.2802, "maximum": 40532.4, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 21436.1 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 21449.0 } ] } ] }, { "description": "MRCP", "code_information": [ { "code": "74181", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4186.8, "discounted_cash": 795.0, "minimum": 95.0796, "maximum": 3349.44, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 95.08, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 303.0 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 941.48 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 202.74 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 303.0 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1046.35 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 1046.35 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 2344.61, "10th_percentile": 2344.61, "90th_percentile": 2344.61, "count": "1 through 10" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 145.53, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 135.83, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 102.84, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 795.49, "10th_percentile": 795.49, "90th_percentile": 812.24, "count": "1 through 10" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 160.08, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 101.87, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 321.17 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 424.08 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 101.87, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 382.42 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 303.0 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 400.07 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 160.08, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 97.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 294.17 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 576.32, "10th_percentile": 576.32, "90th_percentile": 795.49, "count": "1 through 10" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 97.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 97.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 353.74 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 145.53, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "MRI ORBT/FAC/NCK W/WO", "code_information": [ { "code": "70543", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5181.95, "discounted_cash": 984.0, "minimum": 139.0326, "maximum": 4145.56, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 139.03, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 475.54 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 1542.67 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 332.21 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 475.54 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1714.51 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 1714.51 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 212.81, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 198.62, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 150.38, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1105.83, "10th_percentile": 1105.83, "90th_percentile": 1105.83, "count": "1 through 10" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 234.09, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 148.96, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 504.07 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 665.57 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 148.96, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 600.2 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 475.54 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 627.9 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 234.09, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 141.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 461.69 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 141.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 141.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 591.5 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 212.81, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "RESPIRATORY SIGNS, SYMPTOMS AND MISCELLANEOUS DIAGNOSES- SOI : 4", "code_information": [ { "code": "1444", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 21309.23, "maximum": 22587.78, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 22198.48 } ] } ] }, { "description": "DEFIB DUAL CHAMBER", "code_information": [ { "code": "C1721", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 11097.44, "10th_percentile": 11097.44, "90th_percentile": 11097.44, "count": "1 through 10" } ] } ] }, { "description": "ASSAY URINE CHLORIDE", "code_information": [ { "code": "82436", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 28.75, "discounted_cash": 5.0, "minimum": 4.3125, "maximum": 25.82, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5.64, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.12 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 23.23 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5.0 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.12 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 25.82 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 25.82 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.63, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 8.05, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 6.1, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9.49, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 6.04, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.6 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.36 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.04, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 10.24 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.12 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.72 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.49, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.88 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 5.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 8.23 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.63, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "SUTURE ETHILON 5-0 18L", "code_information": [ { "code": "A4649", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 10.66, "10th_percentile": 3.56, "90th_percentile": 309.79, "count": "12" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 9.49, "10th_percentile": 3.56, "90th_percentile": 336.36, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 9.49, "10th_percentile": 8.78, "90th_percentile": 73.99, "count": "1 through 10" } ] } ] }, { "description": "STENT RESOLUTE ONYX 2.25 X 30M", "code_information": [ { "code": "C1874", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 4258.8, "10th_percentile": 4258.8, "90th_percentile": 4420.0, "count": "1 through 10" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1456.46, "10th_percentile": 975.0, "90th_percentile": 4680.0, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1444.95, "10th_percentile": 1444.95, "90th_percentile": 1444.95, "count": "1 through 10" } ] } ] }, { "description": "VAGINAL DELIVERY WITH O.R. PROCEDURES EXCEPT STERILIZATION ANDOR D&C", "code_information": [ { "code": "768", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 3898.0, "maximum": 20266.2, "payers_information": [ { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 6500.0, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 4915.42 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 3898.0 } ] } ] }, { "description": "Cystoscopy and treatment - 52332 - OR36052332", "code_information": [ { "code": "52332", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2209.38, "discounted_cash": 419.0, "minimum": 331.407, "maximum": 6730.4, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1404.8, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 2209.38 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 2143.16 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 2209.38 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 2209.38 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2150.21, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 2006.86, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 1519.48, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2209.38, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1505.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1505.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2209.38, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1433.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1433.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 1433.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2150.21, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "SCREW LO-PRO LOCK TI 4.5X20", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "RADIAL HEAD 22 HD 7.5 STEM10+3", "code_information": [ { "code": "C1776", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 4588.1, "10th_percentile": 1617.12, "90th_percentile": 11630.3, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 9120.0, "10th_percentile": 9120.0, "90th_percentile": 9120.0, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 8640.0, "10th_percentile": 8640.0, "90th_percentile": 9120.0, "count": "1 through 10" } ] } ] }, { "description": "BRAIN CONTUSIONLACERATION & COMPLICATED SKULL FX, COMA < 1 HR OR NO COMA - SOI : 4", "code_information": [ { "code": "0564", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 37850.07, "maximum": 40121.07, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 39429.59 } ] } ] }, { "description": "PLATELETS BACTERIAL MONITOR", "code_information": [ { "code": "P9073", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 734.6, "minimum": 110.19, "maximum": 819.1, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 592.36, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 734.6 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 532.45 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 734.6 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 734.6 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 734.6, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 734.6, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 640.72, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 734.6, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 634.67, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 634.67, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 734.6, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 604.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 604.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 604.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 341.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 734.6, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "HIP BIOPOLAR SMITH&NEPHE", "code_information": [ { "code": "C1776", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 4588.1, "10th_percentile": 1617.12, "90th_percentile": 11630.3, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 9120.0, "10th_percentile": 9120.0, "90th_percentile": 9120.0, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 8640.0, "10th_percentile": 8640.0, "90th_percentile": 9120.0, "count": "1 through 10" } ] } ] }, { "description": "NM THYROID UPTAKE SGL", "code_information": [ { "code": "78014", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2094.96, "discounted_cash": 398.0, "minimum": 159.3186, "maximum": 1675.968, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 159.32, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 509.99 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 909.97 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 195.96 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 509.99 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1011.33 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 1011.33 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 243.86, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 227.6, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 172.32, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 268.24, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 170.7, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 540.59 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 713.79 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 170.7, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 643.68 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 509.99 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 673.39 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 268.24, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 162.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 495.14 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 162.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 162.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 344.33 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 243.86, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "DOPPLER FHT - 76825 - 060036", "code_information": [ { "code": "76825", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 519.74, "discounted_cash": 98.0, "minimum": 77.961, "maximum": 519.74, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 217.77, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 519.74 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 519.74 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 169.62 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 519.74 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 519.74 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 519.74 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 333.32, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 311.09, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 235.54, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 366.65, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 233.32, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 519.74 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 519.74 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 233.32, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 519.74 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 519.74 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 519.74 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 366.65, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 222.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 519.74 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 222.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 222.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 300.8 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 333.32, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "CATH CORDIS 7FR JL6", "code_information": [ { "code": "C1887", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 115.24, "10th_percentile": 81.0, "90th_percentile": 503.66, "count": "23" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 156.51, "10th_percentile": 102.6, "90th_percentile": 572.45, "count": "11" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 129.36, "10th_percentile": 24.35, "90th_percentile": 512.12, "count": "1 through 10" } ] } ] }, { "description": "SCRW BNE 316LXL16 X2.7OD", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "FEM/POP STENT UNILATERAL", "code_information": [ { "code": "37226", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 29289.0, "discounted_cash": 5564.0, "minimum": 4393.35, "maximum": 23431.2, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4423.71, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 13178.28 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 7035.02 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 14664.55 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 14664.55 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6770.99, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 6319.59, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 4784.83, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7448.08, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 4739.69, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4739.69, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7448.08, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 4513.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4513.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 4513.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6770.99, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "G-6-PD QUANT(REF)", "code_information": [ { "code": "82955", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 161.25, "discounted_cash": 30.0, "minimum": 8.439, "maximum": 129.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.51, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.69 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 39.19 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 8.44 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.69 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 43.55 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 43.55 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14.55, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 13.58, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 10.28, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.01, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 10.19, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.51 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.16 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.19, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 17.28 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.69 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.07 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.01, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 9.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.29 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 9.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 9.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 15.86 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.55, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "KIDNEY TRANSPLANT - SOI : 4", "code_information": [ { "code": "4404", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 158036.67, "maximum": 167518.87, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 164631.69 } ] } ] }, { "description": "KIDNEY AND URETER PROCEDURES FOR NON-NEOPLASM WITHOUT CCMCC", "code_information": [ { "code": "661", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 4915.3992, "maximum": 13510.8, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 10191.7 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 9926.38 } ] } ] }, { "description": "IV HYDRAT INIT UP TO 1HR", "code_information": [ { "code": "96360", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 342.5, "discounted_cash": 65.0, "minimum": 33.5472, "maximum": 798.872, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 84.76, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 104.5 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 33.55 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 116.07 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 116.07 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 129.74, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 121.09, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 91.68, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 189.73, "10th_percentile": 124.45, "90th_percentile": 998.59, "count": "13" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 142.71, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 90.81, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 90.81, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 142.71, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 86.49, "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": 19.0, "median_amount": 189.73, "10th_percentile": 179.75, "90th_percentile": 189.73, "count": "1 through 10" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 86.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 86.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 189.73, "10th_percentile": 179.75, "90th_percentile": 213.1, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 129.74, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "Beta-2 Glycoprotein I Ab G,A,M", "code_information": [ { "code": "86146", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 61.05, "discounted_cash": 26.0, "minimum": 9.1575, "maximum": 114.27, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 61.05 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 38.18, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 35.63, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 26.98, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 13.03, "10th_percentile": 13.03, "90th_percentile": 13.03, "count": "1 through 10" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 41.99, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 26.72, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 38.07 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 50.27 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.72, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 45.33 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 35.92 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 47.42 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 41.99, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 34.87 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 41.65 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 38.18, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.94, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 35.92 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 61.05 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 22.14 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 35.92 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 61.05 } ] } ] }, { "description": "Skin sub graft face/nk/hf/g", "code_information": [ { "code": "15275", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3976.88, "discounted_cash": 755.0, "minimum": 294.539, "maximum": 3181.504, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 294.54, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 2158.24 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 1152.15 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 2401.66 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 2401.66 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 450.83, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 420.77, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 318.58, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 754.37, "10th_percentile": 754.37, "90th_percentile": 754.37, "count": "1 through 10" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 495.91, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 315.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 315.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 495.91, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 300.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 300.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 300.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 450.83, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "ACUTE LEUKEMIA - SOI : 1", "code_information": [ { "code": "6901", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 42420.77, "maximum": 44966.01, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 44191.03 } ] } ] }, { "description": "BARTONELLA QUINTANA IGG LC", "code_information": [ { "code": "86611", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 18.3, "discounted_cash": 3.0, "minimum": 2.745, "maximum": 18.3, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.98, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.36 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 18.3 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 8.86 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.36 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 18.3 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 18.3 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.27, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 14.25, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 10.79, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.8, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 10.69, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 15.22 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.3 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.69, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 18.12 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.36 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.3 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.8, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.94 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 16.67 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15.27, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "Administration Fee for Pneumo - G0009 - 006016", "code_information": [ { "code": "G0009", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 111.09, "minimum": 16.6635, "maximum": 111.09, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.66, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 111.09 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 41.7 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 111.09 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 111.09 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 28.56, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 26.66, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 20.18, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 31.42, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 19.99, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.99, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 31.42, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 19.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 19.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 19.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 32.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 28.56, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "COLOPLAST BIATAIN ALGINATE AG", "code_information": [ { "code": "A6196", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 11.33, "10th_percentile": 5.04, "90th_percentile": 70.0, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 3.74, "10th_percentile": 3.74, "90th_percentile": 11.21, "count": "1 through 10" } ] } ] }, { "description": "CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITH MCC", "code_information": [ { "code": "025", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 29250.0, "maximum": 48789.0, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 36535.6 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 43589.21 } ] } ] }, { "description": "HIV W MULTIPLE SIGNIFICANT HIV RELATED CONDITIONS - SOI : 4", "code_information": [ { "code": "8934", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 26096.71, "maximum": 27662.52, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 27185.75 } ] } ] }, { "description": "INBORN ERRORS OF METABOLISM - SOI : 4", "code_information": [ { "code": "4234", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 40361.76, "maximum": 42783.46, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 42046.09 } ] } ] }, { "description": "PACEMAKER DR DC", "code_information": [ { "code": "C1785", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 6147.84, "10th_percentile": 6147.84, "90th_percentile": 6147.84, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 6147.84, "10th_percentile": 6147.84, "90th_percentile": 6147.84, "count": "1 through 10" } ] } ] }, { "description": "SPINAL DISORDERS & INJURIES - SOI : 2", "code_information": [ { "code": "0402", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 28065.0, "maximum": 29748.9, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 29236.18 } ] } ] }, { "description": "SHEATH BRITE TIP 8FR 45CM", "code_information": [ { "code": "C1725", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 462.76, "10th_percentile": 256.45, "90th_percentile": 2515.23, "count": "21" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 270.69, "10th_percentile": 106.59, "90th_percentile": 1342.29, "count": "14" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 484.0, "10th_percentile": 143.56, "90th_percentile": 543.74, "count": "1 through 10" } ] } ] }, { "description": "STENT RESOLUTE ONYX 3.5X15MM", "code_information": [ { "code": "C1874", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 4258.8, "10th_percentile": 4258.8, "90th_percentile": 4420.0, "count": "1 through 10" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1456.46, "10th_percentile": 975.0, "90th_percentile": 4680.0, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1444.95, "10th_percentile": 1444.95, "90th_percentile": 1444.95, "count": "1 through 10" } ] } ] }, { "description": "SHOULDER & ELBOW JOINT REPLACEMENT - SOI : 3", "code_information": [ { "code": "3223", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 33584.98, "maximum": 35600.08, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 34986.51 } ] } ] }, { "description": "NEG PRESSURE WND THER<50 - 97605 - 487010", "code_information": [ { "code": "97605", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 406.7, "discounted_cash": 77.0, "minimum": 45.315, "maximum": 900.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 79.96, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 101.0 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 93.0 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 112.0 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 112.0 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 122.39, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 114.23, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 86.49, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 134.62, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 85.67, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.67, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 134.62, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 81.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 81.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 81.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 122.39, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "GTT 1HR", "code_information": [ { "code": "82951", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 232.5, "discounted_cash": 44.0, "minimum": 11.1969, "maximum": 186.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12.61, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.16 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 51.99 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 11.2 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.16 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 57.79 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 57.79 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.31, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 18.02, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 13.64, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.24, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 13.51, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.25 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.42 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.51, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 22.92 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.16 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.98 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.24, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.63 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 21.07 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.31, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "XR T-SPINE 2 VIEWS", "code_information": [ { "code": "72070", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 575.48, "discounted_cash": 109.0, "minimum": 41.6598, "maximum": 503.24, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 41.66, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 135.95 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 452.8 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 97.51 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 135.95 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 503.24 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 503.24 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 322.27, "10th_percentile": 322.27, "90th_percentile": 391.33, "count": "1 through 10" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 63.77, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 59.51, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 45.06, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 79.48, "10th_percentile": 0.77, "90th_percentile": 257.67, "count": "1 through 10" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 70.14, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 44.64, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 144.11 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 190.28 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 44.64, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "QTC Medical Group", "plan_name": "QTC Medical Group", "methodology": "fee schedule", "standard_charge_dollar": 97.59 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 171.59 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 135.95 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 179.51 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 70.14, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 42.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 131.99 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 42.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 42.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 68.82 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 63.77, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "SCRE COMPRESSION LONG 3X19MM", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "LAP HOOK ELECTRODE", "code_information": [ { "code": "A4649", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 10.66, "10th_percentile": 3.56, "90th_percentile": 309.79, "count": "12" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 9.49, "10th_percentile": 3.56, "90th_percentile": 336.36, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 9.49, "10th_percentile": 8.78, "90th_percentile": 73.99, "count": "1 through 10" } ] } ] }, { "description": "CORT SCREW 2319-46", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "OBSERVATION SBSQ HR(TELE-MS)", "code_information": [ { "code": "G0378", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 450.0, "minimum": 67.5, "maximum": 937.5, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 450.0 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 450.0 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 450.0 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 450.0 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 5952.86, "10th_percentile": 3978.0, "90th_percentile": 8568.0, "count": "16" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 2916.0, "10th_percentile": 792.25, "90th_percentile": 5185.62, "count": "201" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 24.6, "median_amount": 4723.2, "10th_percentile": 2899.66, "90th_percentile": 13219.2, "count": "13" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 24.6, "median_amount": 2720.46, "10th_percentile": 2720.46, "90th_percentile": 11750.4, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 2137.5, "10th_percentile": 769.5, "90th_percentile": 4104.0, "count": "90" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 2310.74, "10th_percentile": 1117.48, "90th_percentile": 4941.0, "count": "64" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 450.0 } ] } ] }, { "description": "IRR PLATELET BACT MONITOR 311", "code_information": [ { "code": "P9073", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 819.1, "minimum": 110.19, "maximum": 819.1, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 592.36, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 819.1 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 532.45 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 819.1 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 819.1 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 819.1, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 819.1, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 640.72, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 819.1, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 634.67, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 634.67, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 819.1, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 604.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 604.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 604.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 341.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 819.1, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "LOWER EXT NON-JOINT W/WO-BILAT", "code_information": [ { "code": "73720", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5204.54, "discounted_cash": 1072.0, "minimum": 139.0326, "maximum": 4517.704, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 139.03, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 475.54 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 1542.67 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 332.21 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 475.54 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1714.51 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 1714.51 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 212.81, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 198.62, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 150.38, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 234.09, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 148.96, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 504.07 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 665.57 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 148.96, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 600.2 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 475.54 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 627.9 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 234.09, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 141.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 461.69 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 141.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 141.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1072.95, "10th_percentile": 1072.95, "90th_percentile": 1072.95, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 591.5 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 212.81, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "ASSAY FREE TESTOSTERONE", "code_information": [ { "code": "84402", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 55.6, "discounted_cash": 26.0, "minimum": 8.34, "maximum": 114.36, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.96, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 35.94 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 55.6 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 22.16 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 35.94 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 55.6 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 55.6 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 78.45, "10th_percentile": 18.7, "90th_percentile": 95.26, "count": "27" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 38.21, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 35.66, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 27.0, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 25.22, "10th_percentile": 5.87, "90th_percentile": 25.22, "count": "1 through 10" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 42.03, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 26.74, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 38.09 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 50.3 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.74, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 45.36 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 35.94 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 47.45 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 42.03, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 25.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 34.89 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 26.62, "10th_percentile": 25.47, "90th_percentile": 26.62, "count": "1 through 10" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 25.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 25.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 5.87, "10th_percentile": 5.87, "90th_percentile": 29.9, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 41.69 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 38.21, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "RESTRATA MINIMATRIX 1000 MG", "code_information": [ { "code": "A2026", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 142.26, "10th_percentile": 142.26, "90th_percentile": 10008.46, "count": "1 through 10" } ] } ] }, { "description": "INTMD RPR FACE/MM 7.6-12.5 CM", "code_information": [ { "code": "12054", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1597.55, "discounted_cash": 303.0, "minimum": 162.0038, "maximum": 1278.04, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 162.0, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 424.95 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 226.85 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 472.87 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 472.87 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 247.97, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 231.43, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 175.23, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 272.76, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 173.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 272.76, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 165.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 165.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 165.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 247.97, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "ALTERATION IN CONSCIOUSNESS - SOI : 4", "code_information": [ { "code": "0524", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 31783.82, "maximum": 33690.85, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 33110.19 } ] } ] }, { "description": "REPAIR ACHILLES TENDON - 27650 - 004065", "code_information": [ { "code": "27650", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7907.08, "discounted_cash": 1502.0, "minimum": 795.375, "maximum": 7907.08, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2891.8, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 7907.08 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 4247.18 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 7907.08 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 7907.08 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4426.23, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 4131.15, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 3127.87, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4868.85, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3098.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3098.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4868.85, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2950.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2950.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 2950.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4426.23, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITH CC", "code_information": [ { "code": "436", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 5173.0836, "maximum": 24769.8, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 7379.12 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 10843.86 } ] } ] }, { "description": "OTHER CHEMOTHERAPY - SOI : 1", "code_information": [ { "code": "6961", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 9457.5, "maximum": 10024.95, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 9852.17 } ] } ] }, { "description": "SIGNS AND SYMPTOMS WITHOUT MCC", "code_information": [ { "code": "948", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 3627.9008, "maximum": 19515.6, "payers_information": [ { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "other", "standard_charge_dollar": 11700.0, "standard_charge_algorithm": "$4,500 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 21000.0, "10th_percentile": 21000.0, "90th_percentile": 21000.0, "count": "1 through 10" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 6168.22 }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "other", "standard_charge_dollar": 13010.4, "standard_charge_algorithm": "5004 per diem", "additional_payer_notes": "standard charge dollar calculated based on AMLOS Medicare", "median_amount": 46268.8, "10th_percentile": 46268.8, "90th_percentile": 46268.8, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 7674.39 } ] } ] }, { "description": "Liver-Kidney MicrosomalAB(REF)", "code_information": [ { "code": "86376", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 62.45, "discounted_cash": 26.0, "minimum": 9.3675, "maximum": 144.76, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 75.0, "median_amount": 123.38, "10th_percentile": 123.38, "90th_percentile": 135.71, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14.26, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.53 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 58.78 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.66 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.53 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 62.45 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 62.45 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 123.05, "10th_percentile": 101.33, "90th_percentile": 123.05, "count": "12" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 21.83, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 20.37, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 15.42, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 38.61, "10th_percentile": 32.57, "90th_percentile": 38.61, "count": "13" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 24.01, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 15.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.76 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28.73 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 25.91 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.53 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.1 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 24.01, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 14.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.93 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 34.38, "10th_percentile": 34.38, "90th_percentile": 34.38, "count": "1 through 10" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 14.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 32.57, "10th_percentile": 32.57, "90th_percentile": 35.1, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 23.82 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.83, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "HIV W MAJOR HIV RELATED CONDITION - SOI : 4", "code_information": [ { "code": "8924", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 23514.35, "maximum": 24925.22, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 24495.63 } ] } ] }, { "description": "HERNIA PROCEDURES EXCEPT INGUINAL, FEMORAL & UMBILICAL - SOI : 1", "code_information": [ { "code": "2271", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 13918.37, "maximum": 14753.48, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 14499.2 } ] } ] }, { "description": "IGA", "code_information": [ { "code": "82784", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 150.0, "discounted_cash": 28.0, "minimum": 3.645, "maximum": 120.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.11, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.12 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 37.57 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 8.09 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.12 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 41.76 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 41.76 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 84.0, "10th_percentile": 44.94, "90th_percentile": 102.0, "count": "1 through 10" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13.95, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 13.02, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 9.86, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 27.0, "10th_percentile": 27.0, "90th_percentile": 64.02, "count": "1 through 10" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15.35, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 9.77, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.91 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.37 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.77, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 16.56 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.12 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.33 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.35, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "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": "fee schedule", "standard_charge_dollar": 12.74 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 28.5, "10th_percentile": 28.5, "90th_percentile": 28.5, "count": "1 through 10" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 9.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 9.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 15.22 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 13.95, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "Anti-Smooth Muscle Ab by IFA", "code_information": [ { "code": "86015", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 137.5, "discounted_cash": 26.0, "minimum": 10.0311, "maximum": 110.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11.81, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.01 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 46.58 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 10.03 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.01 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 51.77 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 51.77 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.08, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 12.77, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.88, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.03 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.8 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 21.46 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.01 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.45 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.88, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.51 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 13.84 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.08, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "2.4MM CORTEX SCREW 26MM", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "MESH PHASIX SURGICAL 20X25CM", "code_information": [ { "code": "C1781", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1862.28, "10th_percentile": 1862.28, "90th_percentile": 11852.02, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1206.78, "10th_percentile": 1206.78, "90th_percentile": 1206.78, "count": "1 through 10" } ] } ] }, { "description": "SIMPLE PNEUMONIA AND PLEURISY WITH MCC", "code_information": [ { "code": "193", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 6052.8126, "maximum": 30024.0, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 8418.99 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 12601.15 } ] } ] }, { "description": "HLTH BHV IVNTJ INDV F2F E AD15", "code_information": [ { "code": "96159", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 381.95, "discounted_cash": 72.0, "minimum": 18.4962, "maximum": 305.56, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 57.61 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 18.5 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 63.99 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 63.99 } ] } ] }, { "description": "CULT CHLAMYDIA", "code_information": [ { "code": "87110", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 208.0, "discounted_cash": 39.0, "minimum": 17.052, "maximum": 166.4, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.21, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.66 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 79.18 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 17.05 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.66 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 88.0 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 88.0 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 29.4, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 27.44, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 20.78, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 32.34, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 20.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 29.31 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 38.71 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 34.91 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.66 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 36.52 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 32.34, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 19.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26.85 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 19.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 19.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 32.08 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 29.4, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "CANC SCREW 2333-40", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "TRACHEOSTOMY FOR FACE, MOUTH AND NECK DIAGNOSES OR LARYNGECTOMY WITHOUT CCMCC", "code_information": [ { "code": "013", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 23946.9, "maximum": 46537.2, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 23946.9 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 27627.82 } ] } ] }, { "description": "Administration Fee for Flu Vac - G0008 - 004324", "code_information": [ { "code": "G0008", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 308.64, "minimum": 16.6635, "maximum": 246.912, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.66, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 64.47 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 20.7 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 71.61 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 71.61 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 28.56, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 26.66, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 20.18, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 31.42, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 19.99, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.99, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 31.42, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 19.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 19.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 19.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 32.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 28.56, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "POST-OP, POST-TRAUMA, OTHER DEVICE INFECTIONS W O.R. PROCEDURE - SOI : 2", "code_information": [ { "code": "7112", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 19366.73, "maximum": 20528.73, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 20174.92 } ] } ] }, { "description": "MRI C-SPINE W/O CONT", "code_information": [ { "code": "72141", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3248.75, "discounted_cash": 617.0, "minimum": 95.0796, "maximum": 2599.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 95.08, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 303.0 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 941.48 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 202.74 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 303.0 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1046.35 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 1046.35 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 1819.3, "10th_percentile": 1819.3, "90th_percentile": 2209.15, "count": "1 through 10" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 145.53, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 135.83, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 102.84, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 1303.43, "10th_percentile": 974.63, "90th_percentile": 3628.01, "count": "1 through 10" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 617.26, "10th_percentile": 584.78, "90th_percentile": 2580.72, "count": "12" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 160.08, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 101.87, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 321.17 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 424.08 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 101.87, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 382.42 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 303.0 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 400.07 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 160.08, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 97.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 294.17 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 617.26, "10th_percentile": 617.26, "90th_percentile": 617.26, "count": "13" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 97.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 97.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 353.74 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 145.53, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "UTERINE & ADNEXA PROCEDURES FOR LEIOMYOMA - SOI : 4", "code_information": [ { "code": "5194", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 47684.8, "maximum": 50545.89, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 49674.74 } ] } ] }, { "description": "ATYPICAL PANCA LC", "code_information": [ { "code": "86256", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 37.05, "discounted_cash": 7.0, "minimum": 5.0445, "maximum": 124.256, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11.81, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.01 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 37.05 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 10.48 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.01 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 37.05 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 37.05 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 86.98, "10th_percentile": 62.24, "90th_percentile": 105.62, "count": "1 through 10" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.08, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 12.77, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 30.13, "10th_percentile": 12.05, "90th_percentile": 30.13, "count": "1 through 10" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.88, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.03 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.8 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 21.46 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.01 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.45 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.88, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.51 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 29.51, "10th_percentile": 29.51, "90th_percentile": 29.51, "count": "1 through 10" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 19.73 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.08, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "UTERINE & ADNEXA PROCEDURES FOR OVARIAN & ADNEXAL MALIGNANCY - SOI : 4", "code_information": [ { "code": "5114", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 65407.0, "maximum": 69331.42, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 68136.5 } ] } ] }, { "description": "MALFUNCTION, REACTION, COMPLIC OF ORTHOPEDIC DEVICE OR PROCEDURE - SOI : 4", "code_information": [ { "code": "3494", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 28660.93, "maximum": 30380.58, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 29856.97 } ] } ] }, { "description": "SELECT SHOULDER STEM14.5", "code_information": [ { "code": "C1776", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 4588.1, "10th_percentile": 1617.12, "90th_percentile": 11630.3, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 9120.0, "10th_percentile": 9120.0, "90th_percentile": 9120.0, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 8640.0, "10th_percentile": 8640.0, "90th_percentile": 9120.0, "count": "1 through 10" } ] } ] }, { "description": "SURGIMESH WN 14X15CM", "code_information": [ { "code": "C1781", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1862.28, "10th_percentile": 1862.28, "90th_percentile": 11852.02, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1206.78, "10th_percentile": 1206.78, "90th_percentile": 1206.78, "count": "1 through 10" } ] } ] }, { "description": "1.6M KIRSCHNER WIRE 150M", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "CATH 5FR OMNIFLUSH 65CM", "code_information": [ { "code": "C1887", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 115.24, "10th_percentile": 81.0, "90th_percentile": 503.66, "count": "23" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 156.51, "10th_percentile": 102.6, "90th_percentile": 572.45, "count": "11" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 129.36, "10th_percentile": 24.35, "90th_percentile": 512.12, "count": "1 through 10" } ] } ] }, { "description": "HEPARIN-NS 1,000 UNIT/500 ML", "drug_information": { "unit": 500.0, "type": "ML" }, "code_information": [ { "code": "00409762003", "type": "NDC" }, { "code": "J1644", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 75.0, "median_amount": 24.24, "10th_percentile": 24.24, "90th_percentile": 24.24, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 21.98, "10th_percentile": 6.72, "90th_percentile": 81.6, "count": "1 through 10" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 25.08, "10th_percentile": 4.56, "90th_percentile": 39.05, "count": "74" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 21.6, "10th_percentile": 2.28, "90th_percentile": 30.4, "count": "48" } ] } ] }, { "description": "CATH MONORAIL 15MMX2.5", "code_information": [ { "code": "C1725", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 462.76, "10th_percentile": 256.45, "90th_percentile": 2515.23, "count": "21" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 270.69, "10th_percentile": 106.59, "90th_percentile": 1342.29, "count": "14" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 484.0, "10th_percentile": 143.56, "90th_percentile": 543.74, "count": "1 through 10" } ] } ] }, { "description": "K&L LIGHT CHAIN(REF)", "code_information": [ { "code": "83883", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 154.0, "discounted_cash": 29.0, "minimum": 11.832, "maximum": 123.2, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13.33, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.19 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 54.94 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 11.83 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.19 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 61.06 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 61.06 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 20.4, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 19.04, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 14.42, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 308.0, "10th_percentile": 308.0, "90th_percentile": 308.0, "count": "1 through 10" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 22.44, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 14.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.34 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26.86 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 24.22 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.19 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.34 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 22.44, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "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": "fee schedule", "standard_charge_dollar": 18.63 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 13.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 58.52, "10th_percentile": 58.52, "90th_percentile": 58.52, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 22.25 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 20.4, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "CXR4V", "code_information": [ { "code": "71048", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 665.0, "discounted_cash": 126.0, "minimum": 41.6598, "maximum": 532.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 41.66, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 135.95 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 452.8 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 97.51 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 135.95 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 503.24 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 503.24 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 63.77, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 59.51, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 45.06, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 70.14, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 44.64, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 144.11 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 190.28 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 44.64, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "QTC Medical Group", "plan_name": "QTC Medical Group", "methodology": "fee schedule", "standard_charge_dollar": 51.82 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 171.59 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 135.95 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 179.51 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 70.14, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 42.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 131.99 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 42.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 42.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 142.49 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 63.77, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "TRT FINGER FRACTURE EACH W/MAN", "code_information": [ { "code": "26725", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1125.45, "discounted_cash": 213.0, "minimum": 77.36, "maximum": 900.36, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 98.3, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 104.6 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 77.36 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 116.59 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 116.59 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 150.47, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 140.43, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 106.33, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 165.51, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 105.33, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 105.33, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 165.51, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 100.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 100.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 100.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 150.47, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "SCREW BNE CORTEX 3.5MMX28MM", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "STENT XIENCE SIERRA 2.25X28MM", "code_information": [ { "code": "C1874", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 4258.8, "10th_percentile": 4258.8, "90th_percentile": 4420.0, "count": "1 through 10" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1456.46, "10th_percentile": 975.0, "90th_percentile": 4680.0, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1444.95, "10th_percentile": 1444.95, "90th_percentile": 1444.95, "count": "1 through 10" } ] } ] }, { "description": "XR KNEE 4+V-RT", "code_information": [ { "code": "73564", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 690.68, "discounted_cash": 131.0, "minimum": 41.6598, "maximum": 552.544, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 41.66, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 135.95 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 452.8 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 97.51 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 135.95 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 503.24 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 503.24 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 63.77, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 59.51, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 45.06, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 70.14, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 44.64, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 144.11 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 190.28 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 44.64, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "QTC Medical Group", "plan_name": "QTC Medical Group", "methodology": "fee schedule", "standard_charge_dollar": 97.59 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 171.59 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 135.95 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 179.51 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 70.14, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 42.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 131.99 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 42.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 42.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 68.82 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 63.77, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "HLTH BHVR IVNTJ INDV F2F EAD15", "code_information": [ { "code": "96159", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 381.95, "discounted_cash": 72.0, "minimum": 18.4962, "maximum": 305.56, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 57.61 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 18.5 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 63.99 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 63.99 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 118.0 } ] } ] }, { "description": "CALPROTECTIN, FECAL LC", "code_information": [ { "code": "83993", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 550.0, "discounted_cash": 104.0, "minimum": 17.0781, "maximum": 440.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.24, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.71 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 79.31 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 17.08 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.71 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 88.14 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 88.14 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 308.0, "10th_percentile": 308.0, "90th_percentile": 308.0, "count": "1 through 10" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 29.45, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 27.48, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 19.63, "10th_percentile": 19.63, "90th_percentile": 99.0, "count": "1 through 10" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 32.39, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 20.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 29.37 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 38.78 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 34.97 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.71 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 36.58 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 32.39, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "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": "fee schedule", "standard_charge_dollar": 26.9 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 104.5, "10th_percentile": 104.5, "90th_percentile": 104.5, "count": "1 through 10" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 19.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 19.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 32.14 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 29.45, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "KNEE TOTAL K1 PLUS ORTHO", "code_information": [ { "code": "C1776", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 4588.1, "10th_percentile": 1617.12, "90th_percentile": 11630.3, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 9120.0, "10th_percentile": 9120.0, "90th_percentile": 9120.0, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 8640.0, "10th_percentile": 8640.0, "90th_percentile": 9120.0, "count": "1 through 10" } ] } ] }, { "description": "SCREW CANCELLOUS 4.0X20M", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "CATH DILATION POWERFLEX 8X60", "code_information": [ { "code": "C1725", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 484.0, "10th_percentile": 143.56, "90th_percentile": 543.74, "count": "1 through 10" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 462.76, "10th_percentile": 256.45, "90th_percentile": 2515.23, "count": "21" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 270.69, "10th_percentile": 106.59, "90th_percentile": 1342.29, "count": "14" } ] } ] }, { "description": "GASTRIC FUNDOPLICATION - SOI : 3", "code_information": [ { "code": "2323", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 19449.82, "maximum": 20616.8, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 20261.47 } ] } ] }, { "description": "EPISTAXIS WITHOUT MCC", "code_information": [ { "code": "151", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 3403.466, "maximum": 16513.2, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 4258.66 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 7036.86 } ] } ] }, { "description": "SLP SWALLOW EVAL 60MIN", "code_information": [ { "code": "92610", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 571.84, "discounted_cash": 98.0, "minimum": 55.8992, "maximum": 457.472, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 55.9, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 201.19 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 64.59 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 223.46 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 223.46 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 85.56, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 79.86, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 60.46, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 155.95, "10th_percentile": 155.95, "90th_percentile": 155.96, "count": "1 through 10" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 108.65, "10th_percentile": 17.32, "90th_percentile": 108.65, "count": "1 through 10" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 94.12, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 59.89, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 59.89, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 94.12, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 57.04, "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": 19.0, "median_amount": 108.65, "10th_percentile": 108.65, "90th_percentile": 108.65, "count": "1 through 10" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 57.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 57.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 79.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 85.56, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "NS 1000ML", "drug_information": { "unit": 1000.0, "type": "ML" }, "code_information": [ { "code": "00264780000", "type": "NDC" }, { "code": "J7030", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 75.0, "median_amount": 16.38, "10th_percentile": 16.38, "90th_percentile": 16.38, "count": "1 through 10" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 14.85, "10th_percentile": 12.23, "90th_percentile": 35.57, "count": "54" } ] } ] }, { "description": "Treat Toe Discloation", "code_information": [ { "code": "28660", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 704.69, "discounted_cash": 133.0, "minimum": 48.94, "maximum": 563.752, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 98.3, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 66.17 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 48.94 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 73.76 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 73.76 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 150.47, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 140.43, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 106.33, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 165.51, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 105.33, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 105.33, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 165.51, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 100.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 100.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 100.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 150.47, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "KNEE & LOWER LEG PROCEDURES EXCEPT FOOT - SOI : 3", "code_information": [ { "code": "3133", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 36313.45, "maximum": 38492.26, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 37828.85 } ] } ] }, { "description": "NEONATE BWT 1000-1249G W RESP DIST SYNDOTH MAJ RESP OR MAJ ANOM - SOI : 3", "code_information": [ { "code": "6023", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 114754.48, "maximum": 121639.75, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 119543.3 } ] } ] }, { "description": "NON-BACTERIAL INFECTIONS OF NERVOUS SYSTEM EXC VIRAL MENINGITIS - SOI : 2", "code_information": [ { "code": "0502", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 25371.86, "maximum": 26894.17, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 26430.65 } ] } ] }, { "description": "MDMA CONFIRMATION(REF) - G0480 - 861050", "code_information": [ { "code": "G0480", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 125.87, "minimum": 18.8805, "maximum": 513.79, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 112.14, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 125.87 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 125.87 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 99.55 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 125.87 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 125.87 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 125.87 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 125.87, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 125.87, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 121.3, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 26.86, "10th_percentile": 17.61, "90th_percentile": 114.43, "count": "1 through 10" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 125.87, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 120.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 125.87 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 125.87 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 120.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 125.87 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 125.87 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 125.87 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 125.87, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 125.87 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 23.92, "10th_percentile": 17.61, "90th_percentile": 137.19, "count": "1 through 10" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 95.93 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 125.87, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "OPTIFOAM AG GENTLE 3.5X10DTRIP", "code_information": [ { "code": "A6212", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 15.49, "10th_percentile": 7.75, "90th_percentile": 44.12, "count": "13" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 20.69, "10th_percentile": 13.07, "90th_percentile": 38.73, "count": "1 through 10" } ] } ] }, { "description": "CLEFT LIP & PALATE REPAIR - SOI : 2", "code_information": [ { "code": "0952", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 16123.5, "maximum": 17090.91, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 16796.35 } ] } ] }, { "description": "GUIDEWIRE SHINOBI 014X300", "code_information": [ { "code": "C1769", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 228.66, "10th_percentile": 43.17, "90th_percentile": 1333.19, "count": "49" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 200.16, "10th_percentile": 45.57, "90th_percentile": 746.52, "count": "29" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 130.22, "10th_percentile": 39.18, "90th_percentile": 442.41, "count": "15" } ] } ] }, { "description": "LEAD PACEMAKER SOLIA T 53", "code_information": [ { "code": "C1898", "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": 19.0, "median_amount": 844.74, "10th_percentile": 844.74, "90th_percentile": 844.74, "count": "1 through 10" } ] } ] }, { "description": "DRILL BIT HOLLOW 16MM", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "BONE SCREW LOCKING 2.7X12MM", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "CATH ASPIRATION EXPORT AP", "code_information": [ { "code": "C1757", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 789.75, "10th_percentile": 416.2, "90th_percentile": 947.7, "count": "1 through 10" } ] } ] }, { "description": "DISORDERS OF PERSONALITY & IMPULSE CONTROL - SOI : 1", "code_information": [ { "code": "7521", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 4394.02, "maximum": 4657.66, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 4577.39 } ] } ] }, { "description": "MALIGNANT BREAST DISORDERS WITH MCC", "code_information": [ { "code": "597", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 7558.2806, "maximum": 36028.8, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 18169.4 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 15982.49 } ] } ] }, { "description": "Muscle-skin graft trunk", "code_information": [ { "code": "15734", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 19928.33, "discounted_cash": 3786.0, "minimum": 1412.2682, "maximum": 15942.664, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1412.27, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 3959.8 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 2113.88 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 4406.39 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 4406.39 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2161.64, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 2017.53, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 1527.56, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 6802.13, "10th_percentile": 6802.13, "90th_percentile": 6802.13, "count": "1 through 10" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2377.8, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1513.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1513.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2377.8, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1441.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1441.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 1441.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2161.64, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "CATH EUPHORA RX 3.0X25MM", "code_information": [ { "code": "C1725", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 462.76, "10th_percentile": 256.45, "90th_percentile": 2515.23, "count": "21" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 270.69, "10th_percentile": 106.59, "90th_percentile": 1342.29, "count": "14" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 484.0, "10th_percentile": 143.56, "90th_percentile": 543.74, "count": "1 through 10" } ] } ] }, { "description": "CTA-HEAD", "code_information": [ { "code": "70496", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3978.57, "discounted_cash": 755.0, "minimum": 69.8936, "maximum": 3182.856, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 69.89, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 227.2 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 736.17 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 158.53 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 227.2 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 818.17 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 818.17 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 2228.0, "10th_percentile": 2228.0, "90th_percentile": 2459.48, "count": "1 through 10" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 106.98, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 99.85, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 75.6, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 755.93, "10th_percentile": 716.14, "90th_percentile": 2458.31, "count": "19" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 117.68, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 74.89, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 240.83 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 317.99 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 74.89, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan Commercial Exchange EPO/HMO", "methodology": "percent of total billed charges", "standard_charge_percentage": 27.55, "median_amount": 290.85, "10th_percentile": 290.85, "90th_percentile": 290.85, "count": "1 through 10" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 286.75 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 227.2 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 299.99 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 117.68, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 71.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 220.58 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 755.93, "10th_percentile": 716.14, "90th_percentile": 755.93, "count": "1 through 10" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 71.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 71.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 771.84, "10th_percentile": 755.93, "90th_percentile": 849.03, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 350.35 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 106.98, "additional_payer_notes": "150.00% 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", "minimum": 11700.0, "maximum": 41072.2, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 41072.2 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 37333.7 } ] } ] }, { "description": "OTHER KIDNEY & URINARY TRACT DIAGNOSES, SIGNS & SYMPTOMS - SOI : 3", "code_information": [ { "code": "4683", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 14840.92, "maximum": 15731.37, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 15460.24 } ] } ] }, { "description": "KIDNEY AND URETER PROCEDURES FOR NEOPLASM WITH CC", "code_information": [ { "code": "657", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 8931.6738, "maximum": 19515.6, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 18653.5 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 17544.21 } ] } ] }, { "description": "SCREW LOW PROFILE TI 5.5X45", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "OTHER EAR, NOSE, MOUTH AND THROAT DIAGNOSES WITH MCC", "code_information": [ { "code": "154", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 7123.265, "maximum": 30774.6, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 11306.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 14989.27 } ] } ] }, { "description": "RPR-INTMD S/A/T/EXT2.6-7.5cmOR", "code_information": [ { "code": "12032", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1665.33, "discounted_cash": 316.0, "minimum": 114.63, "maximum": 1514.888, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 162.0, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 154.99 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 114.63 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 172.75 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 172.75 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 247.97, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 231.43, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 175.23, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 272.76, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 173.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 272.76, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 165.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 165.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 165.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 247.97, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "EPICOCCUM PURPURASENS", "code_information": [ { "code": "86003", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 52.51, "discounted_cash": 3.0, "minimum": 2.445, "maximum": 352.08, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5.12, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.36 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 21.09 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 4.54 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.36 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 23.44 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 23.44 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 37.06, "10th_percentile": 37.06, "90th_percentile": 222.36, "count": "1 through 10" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7.83, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 7.31, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 5.53, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.61, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.81 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.31 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 9.3 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.36 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.72 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.61, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "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": "fee schedule", "standard_charge_dollar": 7.15 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 10.36, "10th_percentile": 10.36, "90th_percentile": 10.36, "count": "1 through 10" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 8.54 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.83, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "NAIL TFN LONG 11MMX300MM LEFT", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "Antiphospholipid Syndrome Prof", "code_information": [ { "code": "85598", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 295.8, "discounted_cash": 56.0, "minimum": 15.6426, "maximum": 236.64, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17.62, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.37 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 72.64 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 15.64 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.37 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 80.73 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 80.73 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 26.97, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 25.17, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 19.06, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 29.67, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 18.88, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26.89 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 35.51 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.88, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 32.02 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.37 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 33.5 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 29.67, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 17.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.63 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 17.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 17.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 29.42 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 26.97, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "STENT RESOLUTE ONYX 4.0 X 34MM", "code_information": [ { "code": "C1874", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 4258.8, "10th_percentile": 4258.8, "90th_percentile": 4420.0, "count": "1 through 10" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1456.46, "10th_percentile": 975.0, "90th_percentile": 4680.0, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1444.95, "10th_percentile": 1444.95, "90th_percentile": 1444.95, "count": "1 through 10" } ] } ] }, { "description": "STENT SENTINOL L60L135C", "code_information": [ { "code": "C1876", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 3100.8, "10th_percentile": 1880.29, "90th_percentile": 7522.24, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 3482.69, "10th_percentile": 3482.69, "90th_percentile": 3482.69, "count": "1 through 10" } ] } ] }, { "description": "SCREW 40MM", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "ST MOD BARIUM SWALLOW", "code_information": [ { "code": "92611", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 523.33, "discounted_cash": 138.0, "minimum": 78.4995, "maximum": 641.304, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 87.23, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 249.05 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 79.95 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 276.62 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 276.62 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 408.1, "10th_percentile": 408.1, "90th_percentile": 408.1, "count": "1 through 10" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 133.52, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 124.61, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 94.35, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 218.63, "10th_percentile": 218.63, "90th_percentile": 240.49, "count": "1 through 10" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 155.52, "10th_percentile": 18.44, "90th_percentile": 171.07, "count": "1 through 10" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 146.87, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 93.46, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 93.46, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 24.6, "median_amount": 198.48, "10th_percentile": 198.48, "90th_percentile": 198.48, "count": "1 through 10" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 146.87, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 89.01, "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": 19.0, "median_amount": 152.31, "10th_percentile": 138.46, "90th_percentile": 152.31, "count": "1 through 10" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 89.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 89.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 155.52, "10th_percentile": 144.29, "90th_percentile": 155.52, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 79.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 133.52, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "DRAINAGE FINGER ABSCESS SIMPLE", "code_information": [ { "code": "26010", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1035.93, "discounted_cash": 196.0, "minimum": 62.69, "maximum": 828.744, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 79.96, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 84.76 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 62.69 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 94.47 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 94.47 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 122.39, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 114.23, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 86.49, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 134.62, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 85.67, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.67, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 24.6, "median_amount": 95.16, "10th_percentile": 95.16, "90th_percentile": 95.16, "count": "1 through 10" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 134.62, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 81.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 81.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 81.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 122.39, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "INTMD RPR FACE/ MM 2.5 CM", "code_information": [ { "code": "12051", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 800.5, "discounted_cash": 266.0, "minimum": 114.63, "maximum": 1122.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 162.0, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 154.99 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 114.63 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 172.75 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 172.75 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 247.97, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 231.43, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 175.23, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 272.76, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 173.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 272.76, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 165.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 165.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 165.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 247.97, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "RED BLOOD CELL DISORDERS WITH MCC", "code_information": [ { "code": "811", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 6361.7568, "maximum": 27772.2, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 10963.1 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 13463.02 } ] } ] }, { "description": "SLEEP LATENCY TEST", "code_information": [ { "code": "95805", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4582.55, "discounted_cash": 870.0, "minimum": 319.4988, "maximum": 3666.04, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 342.23, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 995.22 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 319.5 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1105.39 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 1105.39 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 523.82, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 488.89, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 370.16, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 576.2, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 366.67, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 366.67, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 576.2, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 349.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 349.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 349.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 1061.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 523.82, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "EXT FIX SM CLAMP 4X2.5", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "DRUG SCREEN QUAN LEVETIRACETAM", "code_information": [ { "code": "80177", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 256.88, "discounted_cash": 22.0, "minimum": 11.5275, "maximum": 205.504, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12.99, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.69 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 53.53 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 11.53 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.69 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 59.49 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 59.49 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.88, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 18.55, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 14.05, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 22.13, "10th_percentile": 22.13, "90th_percentile": 22.13, "count": "1 through 10" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.86, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 13.91, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.82 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 26.17 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.91, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 23.6 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.69 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.68 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.86, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.15 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 13.25, "10th_percentile": 13.25, "90th_percentile": 13.25, "count": "1 through 10" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 21.71 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.88, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "NEONATE BWT 2000-2499G W CONGENITALPERINATAL INFECTION - SOI : 1", "code_information": [ { "code": "6231", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 13329.13, "maximum": 14128.88, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 13885.37 } ] } ] }, { "description": "STENT XIENCE SIERRA 4.0MMX8MM", "code_information": [ { "code": "C1874", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 4258.8, "10th_percentile": 4258.8, "90th_percentile": 4420.0, "count": "1 through 10" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1456.46, "10th_percentile": 975.0, "90th_percentile": 4680.0, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1444.95, "10th_percentile": 1444.95, "90th_percentile": 1444.95, "count": "1 through 10" } ] } ] }, { "description": "MAJOR CARDIOTHORACIC REPAIR OF HEART ANOMALY - SOI : 2", "code_information": [ { "code": "1602", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 60762.77, "maximum": 64408.53, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 63298.45 } ] } ] }, { "description": "OTHER DISORDERS OF THE LIVER - SOI : 3", "code_information": [ { "code": "2833", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 11389.5, "maximum": 12072.87, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 11864.79 } ] } ] }, { "description": "DIAG LAPARO SEPARATE PRO", "code_information": [ { "code": "49320", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 9657.5, "discounted_cash": 1834.0, "minimum": 1448.625, "maximum": 7726.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2409.3, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 6428.83 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 3431.93 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 7153.89 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 7153.89 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3687.71, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 3441.86, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 2605.98, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4056.48, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2581.39, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2581.39, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4056.48, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2458.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2458.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 2458.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3687.71, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "TX FX GREAT TOE W/MAN CLSD", "code_information": [ { "code": "28495", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1078.2, "discounted_cash": 204.0, "minimum": 77.36, "maximum": 862.56, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 98.3, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 104.6 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 77.36 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 116.59 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 116.59 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 150.47, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 140.43, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 106.33, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 165.51, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 105.33, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 105.33, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 165.51, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 100.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 100.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 100.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 150.47, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "LYRICA", "drug_information": { "unit": 50.0, "type": "ME" }, "code_information": [ { "code": "00071101368", "type": "NDC" }, { "code": "C9399", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 23.48, "10th_percentile": 17.28, "90th_percentile": 103.66, "count": "1 through 10" } ] } ] }, { "description": "HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITH MCC", "code_information": [ { "code": "480", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 13967.141, "maximum": 47287.8, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 36197.8 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 27920.22 } ] } ] }, { "description": "OTHER MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE PROCEDURES - SOI : 2", "code_information": [ { "code": "3202", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 17949.49, "maximum": 19026.46, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 18698.54 } ] } ] }, { "description": "STENT INTEGRITY RX 3.0X26", "code_information": [ { "code": "C1876", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 3100.8, "10th_percentile": 1880.29, "90th_percentile": 7522.24, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 3482.69, "10th_percentile": 3482.69, "90th_percentile": 3482.69, "count": "1 through 10" } ] } ] }, { "description": "HLA CLASS II Ab SCREEN", "code_information": [ { "code": "86831", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 895.95, "discounted_cash": 170.0, "minimum": 71.2356, "maximum": 716.76, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 80.24, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 115.54 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 330.8 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 71.24 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 115.54 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 367.64 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 367.64 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 122.82, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 114.63, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 86.79, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 135.1, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 85.97, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 122.47 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 161.7 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 85.97, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 145.82 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 115.54 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 152.55 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 135.1, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 81.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 112.17 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 81.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 81.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 113.29 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 122.82, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "URETHRAL PROCEDURES WITH CCMCC", "code_information": [ { "code": "671", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 8204.8006, "maximum": 31525.2, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 16361.7 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 17208.67 } ] } ] }, { "description": "BREAST PROCEDURES EXCEPT MASTECTOMY - SOI : 2", "code_information": [ { "code": "3632", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 22215.54, "maximum": 23548.47, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 23142.61 } ] } ] }, { "description": "ST COG RE-TRAIN 15 MIN", "code_information": [ { "code": "G0515", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 147.5, "minimum": 22.125, "maximum": 118.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 31.06, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 47.54, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 44.37, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 33.59, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 52.29, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 33.27, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 33.27, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 52.29, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 31.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 31.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 31.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 79.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 47.54, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "R&L HRT W/BYPASS", "code_information": [ { "code": "93461", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 20759.3, "discounted_cash": 3944.0, "minimum": 1292.0026, "maximum": 16607.44, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1292.0, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 4702.42 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 2023.46 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 5215.41 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 5215.41 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1977.56, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 1845.72, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 1397.47, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 7318.57, "10th_percentile": 7318.57, "90th_percentile": 7846.15, "count": "1 through 10" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2175.31, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1384.29, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1384.29, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2175.31, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1318.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1318.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 1318.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1977.56, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "MAXIPIME - 44567013010", "drug_information": { "unit": 1.0, "type": "GR" }, "code_information": [ { "code": "44567013010", "type": "NDC" }, { "code": "J0692", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 8.76, "10th_percentile": 4.46, "90th_percentile": 29.5, "count": "1 through 10" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 24.6, "median_amount": 6.75, "10th_percentile": 6.75, "90th_percentile": 12.9, "count": "1 through 10" } ] } ] }, { "description": "CATH BALLOON ADMIRAL 40X130", "code_information": [ { "code": "C1725", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 462.76, "10th_percentile": 256.45, "90th_percentile": 2515.23, "count": "21" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 270.69, "10th_percentile": 106.59, "90th_percentile": 1342.29, "count": "14" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 484.0, "10th_percentile": 143.56, "90th_percentile": 543.74, "count": "1 through 10" } ] } ] }, { "description": "ABORTION WO D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY - SOI : 1", "code_information": [ { "code": "5641", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 3492.49, "maximum": 3702.04, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 3638.23 } ] } ] }, { "description": "CORONARY BYPASS WO AMI OR COMPLEX PDX - SOI : 3", "code_information": [ { "code": "1663", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 51134.31, "maximum": 54202.37, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 53268.2 } ] } ] }, { "description": "HEART FAILURE - SOI : 4", "code_information": [ { "code": "1944", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 31212.72, "maximum": 33085.49, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 32515.26 } ] } ] }, { "description": "ALDOSTERONE(REF)", "code_information": [ { "code": "82088", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 412.23, "discounted_cash": 78.0, "minimum": 6.1125, "maximum": 329.784, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 39.94, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 57.5 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 164.63 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 35.45 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 57.5 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 182.97 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 182.97 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 230.85, "10th_percentile": 230.85, "90th_percentile": 230.85, "count": "1 through 10" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 61.13, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 57.05, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 43.2, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 67.24, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 42.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 60.96 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 80.48 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 42.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 72.58 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 57.5 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 75.93 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 67.24, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "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": "fee schedule", "standard_charge_dollar": 55.83 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 66.72 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 61.13, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "SKIN GRAFT FOR SKIN ULCER OR CELLULITIS WITH MCC", "code_information": [ { "code": "573", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 25571.2514, "maximum": 90822.6, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 58454.9 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 62808.27 } ] } ] }, { "description": "ANGIOTENSIN CONV ENZYME", "code_information": [ { "code": "82164", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 45.0, "discounted_cash": 8.0, "minimum": 6.75, "maximum": 45.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14.31, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.6 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 45.0 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.7 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.6 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 45.0 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 45.0 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 21.9, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 20.44, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 15.48, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 24.09, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 15.33, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.84 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28.83 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.33, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 26.0 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.6 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.2 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 24.09, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.0 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 8.55, "10th_percentile": 8.55, "90th_percentile": 8.55, "count": "1 through 10" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 23.9 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.9, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE O.R. PROCEDURES WITH CC", "code_information": [ { "code": "516", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 9056.3598, "maximum": 29273.4, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 21042.8 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 19922.74 } ] } ] }, { "description": "SCREW BNE 7.3 CANNULATED16X95M", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "INFECTIOUS AND PARASITIC DISEASES WITH O.R. PROCEDURES WITH MCC", "code_information": [ { "code": "853", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 22834.1628, "maximum": 72057.6, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 40551.4 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 47346.36 } ] } ] }, { "description": "TFN SYSTEM HELICAL BLADE 90MM", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "ENDOCRINE DISORDERS WITH MCC", "code_information": [ { "code": "643", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 7681.1194, "maximum": 37530.0, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 12678.5 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 15781.16 } ] } ] }, { "description": "ANOXIC & OTHER SEVERE BRAIN DAMAGE - SOI : 2", "code_information": [ { "code": "0592", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 20304.55, "maximum": 21522.83, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 21151.88 } ] } ] }, { "description": "STENT PCLTXL ELUT3.0X16M", "code_information": [ { "code": "C1874", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 4258.8, "10th_percentile": 4258.8, "90th_percentile": 4420.0, "count": "1 through 10" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1456.46, "10th_percentile": 975.0, "90th_percentile": 4680.0, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1444.95, "10th_percentile": 1444.95, "90th_percentile": 1444.95, "count": "1 through 10" } ] } ] }, { "description": "K-WIRE 1.6 X 152MM", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "SKIN GRAFT, EXCEPT HAND, FOR MUSCULOSKELETAL & CONNECTIVE TISSUE DIAGNOSES - SOI : 4", "code_information": [ { "code": "3124", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 68735.22, "maximum": 72859.34, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 71603.61 } ] } ] }, { "description": "PANCREAS, LIVER AND SHUNT PROCEDURES WITH MCC", "code_information": [ { "code": "405", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 26463.449, "maximum": 63801.0, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 41052.5 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 52445.68 } ] } ] }, { "description": "SCRW BNE VARIABLE ANGLE 5X14", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "GAMMA NAIL SCREW 12X105", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "EXTRACORPOREAL MEMBRANE OXYGENATION (ECMO)- SOI : 1", "code_information": [ { "code": "0091", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 130889.44, "maximum": 138742.81, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 136351.59 } ] } ] }, { "description": "SPINAL FUSION AND OTHER BACK AND NECK PROCEDURES EXCEPT FOR DISC PROCEDURES- SOI : 2", "code_information": [ { "code": "3212", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 29041.02, "maximum": 30783.48, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 30252.93 } ] } ] }, { "description": "CORT SCREW 2323-22", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "TOTAL KNEE", "code_information": [ { "code": "27447", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 21462.0, "discounted_cash": 1700.0, "minimum": 1342.62, "maximum": 17613.05, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5116.57, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 15827.94 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 8449.5 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 17613.05 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 17613.05 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7831.49, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 7309.39, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 5534.25, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8614.63, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5482.04, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5482.04, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8614.63, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5220.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5220.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 5220.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7831.49, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "PULMONARY EMBOLISM - SOI : 1", "code_information": [ { "code": "1341", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 8438.5, "maximum": 8944.81, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 8790.65 } ] } ] }, { "description": "STENT DELIVERY SYSTEM 2.5X23", "code_information": [ { "code": "C1876", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 3100.8, "10th_percentile": 1880.29, "90th_percentile": 7522.24, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 3482.69, "10th_percentile": 3482.69, "90th_percentile": 3482.69, "count": "1 through 10" } ] } ] }, { "description": "FACTOR II(PROTHROMBIN)DNA ANAL", "code_information": [ { "code": "81240", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 137.55, "discounted_cash": 26.0, "minimum": 20.6325, "maximum": 137.55, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 64.38, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 92.7 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 137.55 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 57.15 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 92.7 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 137.55 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 137.55 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 98.54, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 91.97, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 69.63, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 108.39, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 68.97, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 98.26 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 129.74 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 68.97, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 117.0 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 92.7 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 122.4 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 108.39, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 65.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 90.0 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 65.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 65.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 80.56 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 98.54, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "SKIN ULCERS - SOI : 3", "code_information": [ { "code": "3803", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 12309.18, "maximum": 13047.73, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 12822.85 } ] } ] }, { "description": "HAND & WRIST PROCEDURES - SOI : 2", "code_information": [ { "code": "3162", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 16434.84, "maximum": 17420.93, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 17120.68 } ] } ] }, { "description": "SUTURE PROLENE6 RB-2", "code_information": [ { "code": "C1769", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 228.66, "10th_percentile": 43.17, "90th_percentile": 1333.19, "count": "49" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 200.16, "10th_percentile": 45.57, "90th_percentile": 746.52, "count": "29" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 130.22, "10th_percentile": 39.18, "90th_percentile": 442.41, "count": "15" } ] } ] }, { "description": "ACUTE ANXIETY & DELIRIUM STATES - SOI : 3", "code_information": [ { "code": "7563", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 10414.43, "maximum": 11039.29, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 10849.03 } ] } ] }, { "description": "VASOSEAL ES", "code_information": [ { "code": "C1760", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 1856.4, "10th_percentile": 1856.4, "90th_percentile": 1856.4, "count": "1 through 10" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 570.57, "10th_percentile": 513.23, "90th_percentile": 975.65, "count": "28" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 555.75, "10th_percentile": 518.7, "90th_percentile": 1012.7, "count": "23" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 526.5, "10th_percentile": 513.23, "90th_percentile": 1089.27, "count": "11" } ] } ] }, { "description": "FEMORAL COMPONENT TIGHT SZ 3", "code_information": [ { "code": "C1776", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 4588.1, "10th_percentile": 1617.12, "90th_percentile": 11630.3, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 9120.0, "10th_percentile": 9120.0, "90th_percentile": 9120.0, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 8640.0, "10th_percentile": 8640.0, "90th_percentile": 9120.0, "count": "1 through 10" } ] } ] }, { "description": "COCAINE ABUSE & DEPENDENCE - SOI : 1", "code_information": [ { "code": "7741", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 3205.03, "maximum": 3397.33, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 3338.78 } ] } ] }, { "description": "US RENAL", "code_information": [ { "code": "76770", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1216.88, "discounted_cash": 231.0, "minimum": 41.6598, "maximum": 973.504, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 41.66, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 135.95 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 452.8 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 97.51 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 135.95 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 503.24 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 503.24 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 741.98, "10th_percentile": 681.45, "90th_percentile": 827.48, "count": "1 through 10" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 63.77, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 59.51, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 45.06, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 365.06, "10th_percentile": 360.08, "90th_percentile": 365.06, "count": "1 through 10" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 259.68, "10th_percentile": 216.05, "90th_percentile": 1034.46, "count": "29" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 70.14, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 44.64, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 144.11 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 190.28 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 44.64, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 171.59 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 135.95 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 179.51 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 70.14, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 42.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 131.99 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 231.21, "10th_percentile": 228.05, "90th_percentile": 231.21, "count": "17" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 42.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 42.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 231.21, "10th_percentile": 216.05, "90th_percentile": 236.07, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 161.48 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 63.77, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "SCREW 7.3X120MM CANNULATED", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "TIBIAL NAIL EXW PROX 10X345MM", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "CATHETER GUIDING WMS POST 6FR", "code_information": [ { "code": "C1887", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 115.24, "10th_percentile": 81.0, "90th_percentile": 503.66, "count": "23" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 156.51, "10th_percentile": 102.6, "90th_percentile": 572.45, "count": "11" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 129.36, "10th_percentile": 24.35, "90th_percentile": 512.12, "count": "1 through 10" } ] } ] }, { "description": "TOMO MAMMO SCREEN--RT", "code_information": [ { "code": "77063", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 176.0, "discounted_cash": 47.0, "minimum": 11.6175, "maximum": 200.8, "payers_information": [ { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 23.3, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.3, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 36.61, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 22.19, "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": 19.0, "median_amount": 47.69, "10th_percentile": 47.69, "90th_percentile": 47.69, "count": "59" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 22.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 22.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 22.19 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 30.94 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 33.29, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 75.0, "median_amount": 188.25, "10th_percentile": 188.25, "90th_percentile": 188.25, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 21.75, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 101.93 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 21.95 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 113.28 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 113.28 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 140.56, "10th_percentile": 105.32, "90th_percentile": 170.68, "count": "29" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 33.29, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 31.07, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 23.52, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 75.3, "10th_percentile": 46.46, "90th_percentile": 75.3, "count": "43" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 49.05, "10th_percentile": 49.05, "90th_percentile": 128.68, "count": "80" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 36.61, "additional_payer_notes": "165.00% of Medicare Rates" } ] } ] }, { "description": "MODERATELY EXTENSIVE OR PROCEDURES FOR OTHER COMPLICATIONS OF TREATMENT - SOI : 3", "code_information": [ { "code": "7933", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 44061.48, "maximum": 46705.17, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 45900.21 } ] } ] }, { "description": "GC & CHLAMYDIA <21", "code_information": [ { "code": "87491", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 35.09, "discounted_cash": 8.0, "minimum": 5.2635, "maximum": 433.504, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 34.39, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 35.09 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 35.09 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 30.53 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 35.09 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 35.09 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 35.09 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 140.85, "10th_percentile": 140.85, "90th_percentile": 140.85, "count": "1 through 10" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 35.09 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 35.09 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 35.09 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 35.09 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 35.09 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 35.09 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 35.09 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "FIBERGRAFT BG PUTTY 1CC", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "PTA ILIAC INITIAL", "code_information": [ { "code": "37220", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 15116.4, "discounted_cash": 2872.0, "minimum": 2224.0414, "maximum": 12093.12, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2224.04, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 6588.7 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 3517.28 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 7331.79 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 7331.79 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3404.15, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 3177.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 2405.6, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3744.56, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2382.9, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2382.9, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3744.56, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2269.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2269.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 2269.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3404.15, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "PLATE TIBIA RIGHT 3.5X147", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "US SCREENING AORTA-MEDICARE - 76706 - 710105", "code_information": [ { "code": "76706", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 252.0, "discounted_cash": 47.0, "minimum": 37.8, "maximum": 315.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 41.66, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 135.95 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 252.0 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 75.87 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 135.95 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 252.0 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 252.0 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 63.77, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 59.51, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 45.06, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 70.14, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 44.64, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 144.11 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 190.28 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 44.64, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 171.59 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 135.95 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 179.51 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 70.14, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 42.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 131.99 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 59.85, "10th_percentile": 59.85, "90th_percentile": 59.85, "count": "1 through 10" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 42.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 42.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 135.23 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 63.77, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "TRAUMATIC STUPOR AND COMA <1 HOUR WITHOUT CCMCC", "code_information": [ { "code": "087", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 6660.79, "maximum": 14261.4, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 6660.79 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 8769.23 } ] } ] }, { "description": "ANATOMIC BALL HEADR20/15", "code_information": [ { "code": "C1776", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 4588.1, "10th_percentile": 1617.12, "90th_percentile": 11630.3, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 9120.0, "10th_percentile": 9120.0, "90th_percentile": 9120.0, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 8640.0, "10th_percentile": 8640.0, "90th_percentile": 9120.0, "count": "1 through 10" } ] } ] }, { "description": "SARS ANTIGEN FIA", "code_information": [ { "code": "87426", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 194.32, "discounted_cash": 36.0, "minimum": 29.148, "maximum": 155.456, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 75.0, "median_amount": 60.38, "10th_percentile": 60.38, "90th_percentile": 60.38, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 34.62, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 49.85 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 45.23 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 45.23 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 49.85 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 45.23 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 45.23 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 132.14, "10th_percentile": 54.74, "90th_percentile": 132.14, "count": "24" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 53.0, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 49.46, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Gray Count Insurance MGMT Systems", "plan_name": "Gray County Insurance MGMT Systems", "methodology": "percent of total billed charges", "standard_charge_percentage": 50.0, "median_amount": 79.32, "10th_percentile": 79.32, "90th_percentile": 79.32, "count": "1 through 10" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 37.45, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 36.92, "10th_percentile": 17.18, "90th_percentile": 41.47, "count": "63" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 58.29, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 37.1, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 52.84 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 69.77 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 37.1, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 62.92 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 49.85 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 65.82 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 58.29, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 35.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 48.4 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 36.92, "10th_percentile": 36.92, "90th_percentile": 36.92, "count": "25" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 35.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 35.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 17.18, "10th_percentile": 17.18, "90th_percentile": 41.47, "count": "19" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 54.44 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 53.0, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "NPWT >50CM 45MIN", "code_information": [ { "code": "97606", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1199.0, "discounted_cash": 85.0, "minimum": 63.675, "maximum": 1666.376, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 162.0, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 101.0 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 93.0 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 112.0 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 112.0 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 247.97, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 231.43, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 175.23, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 272.76, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 173.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 272.76, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 165.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 165.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 165.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 247.97, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "MUSCULOSKELETAL & OTHER PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA - SOI : 2", "code_information": [ { "code": "9122", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 27994.33, "maximum": 29673.98, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 29162.56 } ] } ] }, { "description": "DRAINAGE OF SKIN ABSCESS - 10061 - 034819", "code_information": [ { "code": "10061", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1333.44, "discounted_cash": 240.0, "minimum": 82.0, "maximum": 4242.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 162.0, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 110.87 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 82.0 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 123.57 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 123.57 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 247.97, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 231.43, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 175.23, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 272.76, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 173.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 272.76, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 165.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 165.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 165.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "percent of total billed charges", "standard_charge_percentage": 54.8, "median_amount": 138.34, "10th_percentile": 138.34, "90th_percentile": 138.34, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 247.97, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "MALIGNANCY, MALE REPRODUCTIVE SYSTEM WITH CC", "code_information": [ { "code": "723", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 5029.4638, "maximum": 25520.4, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 10658.6 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 10955.06 } ] } ] }, { "description": "BACTERIAL & TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM - SOI : 4", "code_information": [ { "code": "0494", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 60431.38, "maximum": 64057.26, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 62953.24 } ] } ] }, { "description": "ESTRADIOL", "code_information": [ { "code": "82670", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 434.5, "discounted_cash": 82.0, "minimum": 24.3078, "maximum": 415.2, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 27.38, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 39.43 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 112.88 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 24.31 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 39.43 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 125.45 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 125.45 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 268.6, "10th_percentile": 243.32, "90th_percentile": 295.46, "count": "14" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 41.91, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 39.12, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 29.62, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 92.72, "10th_percentile": 27.94, "90th_percentile": 92.72, "count": "1 through 10" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 46.1, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 29.34, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 41.79 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 55.18 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.34, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 49.76 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 39.43 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 52.06 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 46.1, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "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": "fee schedule", "standard_charge_dollar": 38.28 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 82.56, "10th_percentile": 27.94, "90th_percentile": 82.56, "count": "1 through 10" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 27.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 27.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 78.21, "10th_percentile": 78.21, "90th_percentile": 84.29, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 45.74 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 41.91, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "DIGESTIVE MALIGNANCY - SOI : 2", "code_information": [ { "code": "2402", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 11447.75, "maximum": 12134.62, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 11925.48 } ] } ] }, { "description": "GLUCOSE, BODY FLUID - 82945 - 800661", "code_information": [ { "code": "82945", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 11.25, "discounted_cash": 2.0, "minimum": 1.6875, "maximum": 127.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3.85, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.54 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 11.25 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3.42 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.54 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 11.25 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 11.25 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5.9, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 5.5, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 4.17, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 4.13, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.87 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.76 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.13, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 6.99 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.54 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.32 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.38 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 3.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 6.43 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5.9, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "MAJOR CRANIALFACIAL BONE PROCEDURES - SOI : 3", "code_information": [ { "code": "0893", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 50349.29, "maximum": 53370.25, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 52450.42 } ] } ] }, { "description": "SCREW LONG THREAD 4.0X46 - C1713 - 043845", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "UTERINE & ADNEXA PROCEDURES FOR NON-OVARIAN & NON-ADNEXAL MALIG - SOI : 1", "code_information": [ { "code": "5121", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 16280.12, "maximum": 17256.93, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 16959.51 } ] } ] }, { "description": "MRI C SPINE W/CONTRAST", "code_information": [ { "code": "72142", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4344.76, "discounted_cash": 825.0, "minimum": 139.0326, "maximum": 3475.808, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 139.03, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 475.54 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 1542.67 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 332.21 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 475.54 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1714.51 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 1714.51 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 212.81, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 198.62, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 150.38, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 234.09, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 148.96, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 504.07 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 665.57 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 148.96, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 600.2 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 475.54 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 627.9 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 234.09, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 141.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 461.69 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 141.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 141.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 511.79 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 212.81, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "SMEAR WET MOUNT", "code_information": [ { "code": "87210", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 96.0, "discounted_cash": 18.0, "minimum": 5.0634, "maximum": 76.8, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5.7, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.21 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 23.51 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5.06 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.21 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 26.13 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 26.13 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.73, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 8.15, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 6.17, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9.6, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 6.11, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.7 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 11.49 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.11, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 10.36 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.21 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.84 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.6, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.97 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 5.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 6.98 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.73, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "TILKING SCREW W/T25 5X30MM", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "NM ACUTE GI BLOOD LOSS", "code_information": [ { "code": "78278", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2094.96, "discounted_cash": 398.0, "minimum": 159.3186, "maximum": 1675.968, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 159.32, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 504.43 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 1262.34 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 271.84 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 504.43 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1402.95 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 1402.95 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 243.86, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 227.6, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 172.32, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 268.24, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 170.7, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 534.7 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 706.01 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 170.7, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 636.66 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 504.43 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 666.05 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 268.24, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 162.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 489.74 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 162.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 162.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 388.54 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 243.86, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "GAMMA NAIL LEFT 360MM", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "CARDIZEM - 55390056505", "drug_information": { "unit": 25.0, "type": "ML" }, "code_information": [ { "code": "55390056505", "type": "NDC" }, { "code": "J3490", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "minimum": 1.0, "maximum": 4.72, "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 2.28, "10th_percentile": 0.64, "90th_percentile": 22.8, "count": "56" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 5.47, "10th_percentile": 1.14, "90th_percentile": 22.8, "count": "54" } ] } ] }, { "description": "PREALBUMIN(REF)", "code_information": [ { "code": "84134", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 188.38, "discounted_cash": 35.0, "minimum": 12.6933, "maximum": 150.704, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14.3, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.59 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 58.94 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.69 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.59 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 65.51 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 65.51 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 21.89, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 20.43, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 15.47, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 24.07, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.83 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28.82 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 25.99 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.59 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.19 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 24.07, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 14.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.99 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 35.79, "10th_percentile": 35.79, "90th_percentile": 35.79, "count": "1 through 10" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 14.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 23.87 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.89, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "SPECIMEN HANDLING PT-LAB - 99001 - 800043", "code_information": [ { "code": "99001", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 40.0, "discounted_cash": 11.0, "minimum": 5.3331, "maximum": 47.2, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 24.77 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5.33 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 27.52 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 27.52 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 9.46 } ] } ] }, { "description": "LYMPHOMA, MYELOMA & NON-ACUTE LEUKEMIA - SOI : 2", "code_information": [ { "code": "6912", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 18438.46, "maximum": 19544.76, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 19207.91 } ] } ] }, { "description": "PLATELETS BACT MONITOR 311", "code_information": [ { "code": "P9073", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 734.6, "minimum": 110.19, "maximum": 819.1, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 592.36, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 734.6 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 532.45 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 734.6 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 734.6 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 734.6, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 734.6, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 640.72, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 734.6, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 634.67, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 634.67, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 734.6, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 604.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 604.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 604.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 341.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 734.6, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "SCREW CORTICLE 4.5X46MM", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "SICKLE CELL ANEMIA CRISIS - SOI : 4", "code_information": [ { "code": "6624", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 38083.09, "maximum": 40368.08, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 39672.34 } ] } ] }, { "description": "THER/PROPH/DIAG INJ SC/IM(NUR)", "code_information": [ { "code": "96372", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 202.03, "discounted_cash": 64.0, "minimum": 28.6944, "maximum": 269.856, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 28.69, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 163.87 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 52.61 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 182.01 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 182.01 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 43.92, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 40.99, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 31.04, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 64.09, "10th_percentile": 60.72, "90th_percentile": 337.32, "count": "25" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 48.31, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 30.74, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30.74, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 48.31, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 29.28, "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": 19.0, "median_amount": 64.09, "10th_percentile": 64.09, "90th_percentile": 64.09, "count": "1 through 10" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 29.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 29.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 64.09, "10th_percentile": 60.72, "90th_percentile": 64.09, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 202.03 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 43.92, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "INSERTION OF HEART PACEMAKER", "code_information": [ { "code": "33207", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 41250.0, "discounted_cash": 7837.0, "minimum": 4165.4116, "maximum": 33000.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4165.41, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 13635.08 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 7278.88 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 15172.87 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 15172.87 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6375.63, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 5950.59, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 4505.45, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7013.19, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 4462.94, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4462.94, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7013.19, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 4250.42, "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": 19.0, "median_amount": 7837.5, "10th_percentile": 7837.5, "90th_percentile": 7837.5, "count": "1 through 10" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4250.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 4250.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6375.63, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "BURNS WITH SKIN GRAFT EXCEPT EXTENSIVE 3RD DEGREE BURNS - SOI : 4", "code_information": [ { "code": "8424", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 83082.4, "maximum": 88067.34, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 86549.51 } ] } ] }, { "description": "IRRIG DRUG DELIVERY DEVICE - 96523 - 006010", "code_information": [ { "code": "96523", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 232.64, "discounted_cash": 54.0, "minimum": 23.5004, "maximum": 232.64, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 23.5, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 149.08 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 47.86 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 165.58 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 165.58 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 35.97, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 33.57, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 25.42, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 39.57, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 25.18, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.18, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 39.57, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 23.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 23.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 23.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 232.64 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 35.97, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "SURGIMESH WN 5X10CM", "code_information": [ { "code": "C1781", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1862.28, "10th_percentile": 1862.28, "90th_percentile": 11852.02, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1206.78, "10th_percentile": 1206.78, "90th_percentile": 1206.78, "count": "1 through 10" } ] } ] }, { "description": "MEDIAL DISTAL TIBIA PLATE 8 HL", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "MRA NECK WITH CONTRAST", "code_information": [ { "code": "70548", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4130.63, "discounted_cash": 784.0, "minimum": 139.0326, "maximum": 3304.504, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 139.03, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 475.54 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 1542.67 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 332.21 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 475.54 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1714.51 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 1714.51 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 212.81, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 198.62, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 150.38, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 234.09, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 148.96, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 504.07 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 665.57 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 148.96, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 600.2 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 475.54 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 627.9 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 234.09, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 141.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 461.69 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 141.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 141.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 511.79 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 212.81, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "SURG PATH LEVEL 6", "code_information": [ { "code": "88309", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4258.96, "discounted_cash": 809.0, "minimum": 215.6, "maximum": 3407.168, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 321.09, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 2537.93 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 546.53 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2820.62 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 2820.62 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 491.46, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 458.7, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 347.3, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 540.61, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 344.02, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 344.02, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 540.61, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 327.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 327.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 327.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 215.6 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 491.46, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "STENT RESOLUTE ONYX 3.0MM X 38", "code_information": [ { "code": "C1874", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 4258.8, "10th_percentile": 4258.8, "90th_percentile": 4420.0, "count": "1 through 10" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1456.46, "10th_percentile": 975.0, "90th_percentile": 4680.0, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1444.95, "10th_percentile": 1444.95, "90th_percentile": 1444.95, "count": "1 through 10" } ] } ] }, { "description": "XR MYELOGRAM 2 OR MORE REGIONS", "code_information": [ { "code": "72270", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2705.5, "discounted_cash": 514.0, "minimum": 312.4142, "maximum": 2705.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 312.41, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 990.07 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 2705.5 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 592.31 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 990.07 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2705.5 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 2705.5 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 478.19, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 446.31, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 337.92, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 526.0, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 334.73, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1049.47 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1385.71 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 334.73, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 1249.6 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 990.07 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1307.27 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 526.0, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 318.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 961.23 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 318.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 318.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 716.89 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 478.19, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "SCREW BNE VARIABLE ANGLE 5X32", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "XR SPEECH EV COMPLEX", "code_information": [ { "code": "70371", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 745.2, "discounted_cash": 141.0, "minimum": 95.0796, "maximum": 745.2, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 95.08, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 303.0 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 745.2 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 202.74 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 303.0 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 745.2 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 745.2 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 145.53, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 135.83, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 102.84, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 160.08, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 101.87, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 321.17 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 424.08 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 101.87, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 382.42 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 303.0 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 400.07 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 160.08, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 97.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 294.17 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 97.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 97.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 188.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 145.53, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "CPR - 92950 - 092951", "code_information": [ { "code": "92950", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 497.5, "discounted_cash": 291.0, "minimum": 74.625, "maximum": 1298.8, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 86.05, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 336.62 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 179.7 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 374.59 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 374.59 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 131.72, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 122.93, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 93.08, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 292.23, "10th_percentile": 235.41, "90th_percentile": 308.46, "count": "1 through 10" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 144.89, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 92.2, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 92.2, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 24.6, "median_amount": 708.18, "10th_percentile": 708.18, "90th_percentile": 708.18, "count": "1 through 10" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 144.89, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 87.81, "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": 19.0, "median_amount": 308.47, "10th_percentile": 308.47, "90th_percentile": 308.47, "count": "1 through 10" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 87.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 87.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 94.53, "10th_percentile": 94.53, "90th_percentile": 94.53, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 131.72, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "BARE METAL STENT 12MM4.0", "code_information": [ { "code": "C1876", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 3100.8, "10th_percentile": 1880.29, "90th_percentile": 7522.24, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 3482.69, "10th_percentile": 3482.69, "90th_percentile": 3482.69, "count": "1 through 10" } ] } ] }, { "description": "PATH DECALCIFICATION", "code_information": [ { "code": "88311", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 140.25, "discounted_cash": 26.0, "minimum": 7.8387, "maximum": 112.2, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 36.4 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 7.84 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 40.45 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 40.45 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 9.46 } ] } ] }, { "description": "CORT SCREW 2323-40", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "CONNECTIVE TISSUE DISORDERS - SOI : 1", "code_information": [ { "code": "3461", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 10598.75, "maximum": 11234.67, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 11041.04 } ] } ] }, { "description": "PLATE COVERLEAF STANDARD 2.4", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "MALNUTRITION, FAILURE TO THRIVE & OTHER NUTRITIONAL DISORDERS - SOI : 2", "code_information": [ { "code": "4212", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 13247.0, "maximum": 14041.82, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 13799.81 } ] } ] }, { "description": "TFNA FENESTRATED HELICALBLD 75", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "CATHETER GUIDING JL 4.5 6FR", "code_information": [ { "code": "C1725", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 462.76, "10th_percentile": 256.45, "90th_percentile": 2515.23, "count": "21" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 270.69, "10th_percentile": 106.59, "90th_percentile": 1342.29, "count": "14" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 484.0, "10th_percentile": 143.56, "90th_percentile": 543.74, "count": "1 through 10" } ] } ] }, { "description": "OTHER CHEMOTHERAPY - SOI : 3", "code_information": [ { "code": "6963", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 22873.54, "maximum": 24245.95, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 23828.08 } ] } ] }, { "description": "CATHETER ATHERECTOMY SOLID 145", "code_information": [ { "code": "C1714", "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": 19.0, "median_amount": 5690.5, "10th_percentile": 5690.5, "90th_percentile": 5690.5, "count": "1 through 10" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 5690.5, "10th_percentile": 5690.5, "90th_percentile": 5690.5, "count": "1 through 10" } ] } ] }, { "description": "NM INTESTINE IMAGING", "code_information": [ { "code": "78290", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1486.0, "discounted_cash": 282.0, "minimum": 159.3186, "maximum": 1388.4, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 159.32, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 504.43 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 1249.25 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 269.02 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 504.43 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1388.4 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 1388.4 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 243.86, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 227.6, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 172.32, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 268.24, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 170.7, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 534.7 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 706.01 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 170.7, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 636.66 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 504.43 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 666.05 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 268.24, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 162.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 489.74 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 162.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 162.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 388.54 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 243.86, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITHOUT CCMCC", "code_information": [ { "code": "241", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 7349.0852, "maximum": 33026.4, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 14332.4 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 13272.24 } ] } ] }, { "description": "TC99M DMSA", "code_information": [ { "code": "A9551", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1111.8, "minimum": 166.77, "maximum": 1111.8, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 646.73, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 1111.8 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 519.41 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1111.8 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 1111.8 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 989.9, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 923.9, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 699.53, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1088.88, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 692.93, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 692.93, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1088.88, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 659.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 659.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 659.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 699.53 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 989.9, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "OT NEUROMUSC RE-ED 15MIN", "code_information": [ { "code": "97112", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 174.63, "discounted_cash": 39.0, "minimum": 26.1945, "maximum": 166.104, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 31.26, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 96.69 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 31.04 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 107.4 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 107.4 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 47.85, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 44.66, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 33.81, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 283.24, "10th_percentile": 283.24, "90th_percentile": 283.24, "count": "1 through 10" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 52.64, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 33.5, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 33.5, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 52.64, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 31.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 31.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 31.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 79.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 47.85, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "CATHETER NC EUPHORA37520X", "code_information": [ { "code": "C1725", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 462.76, "10th_percentile": 256.45, "90th_percentile": 2515.23, "count": "21" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 270.69, "10th_percentile": 106.59, "90th_percentile": 1342.29, "count": "14" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 484.0, "10th_percentile": 143.56, "90th_percentile": 543.74, "count": "1 through 10" } ] } ] }, { "description": "EXC H-F-NK-SP B9+MARG 0.5/<", "code_information": [ { "code": "11420", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3904.5, "discounted_cash": 741.0, "minimum": 63.03, "maximum": 3123.6, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 658.2, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 85.23 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 63.03 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 94.99 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 94.99 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1007.45, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 940.28, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 711.93, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1108.19, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 705.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 705.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1108.19, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 671.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 671.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 671.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1007.45, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "PENIS PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "710", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 7388.3382, "maximum": 14831.073, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 13677.3 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 13433.3 } ] } ] }, { "description": "CORT SCREW 2319-40", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "BIO TENODISIS SCREW", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITHOUT INTRALUMINAL DEVICE WITH MCC", "code_information": [ { "code": "250", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 11650.2904, "maximum": 24769.8, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 18695.4 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 20923.63 } ] } ] }, { "description": "GUIDEWIRE PILOT 50 .014X300CM", "code_information": [ { "code": "C1769", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 228.66, "10th_percentile": 43.17, "90th_percentile": 1333.19, "count": "49" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 200.16, "10th_percentile": 45.57, "90th_percentile": 746.52, "count": "29" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 130.22, "10th_percentile": 39.18, "90th_percentile": 442.41, "count": "15" } ] } ] }, { "description": "AMIKACIN TROUGH(REF)", "code_information": [ { "code": "80150", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 50.0, "discounted_cash": 9.0, "minimum": 7.5, "maximum": 50.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.28 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 50.0 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 13.12 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.28 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 50.0 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 50.0 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.62, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 21.11, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 15.98, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 24.88, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 15.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.56 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 29.78 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 26.86 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.28 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28.1 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 24.88, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "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": "fee schedule", "standard_charge_dollar": 20.66 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 24.67 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 22.62, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "LIVER TRANSPLANT &OR INTESTINAL TRANSPLANT - SOI : 3", "code_information": [ { "code": "0013", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 109046.36, "maximum": 115589.15, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 113596.97 } ] } ] }, { "description": "AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITH MCC", "code_information": [ { "code": "474", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 18808.1904, "maximum": 76561.2, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 49328.7 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 41156.03 } ] } ] }, { "description": "GUIDEWIRE PTCA MAILMAN 182CM", "code_information": [ { "code": "C1725", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 462.76, "10th_percentile": 256.45, "90th_percentile": 2515.23, "count": "21" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 270.69, "10th_percentile": 106.59, "90th_percentile": 1342.29, "count": "14" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 484.0, "10th_percentile": 143.56, "90th_percentile": 543.74, "count": "1 through 10" } ] } ] }, { "description": "SIMPLE PNEUMONIA AND PLEURISY WITH CC", "code_information": [ { "code": "194", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 3985.334, "maximum": 21016.8, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 6003.18 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 7726.16 } ] } ] }, { "description": "CARDIAC RHYTHM RECORDER IMPLAN", "code_information": [ { "code": "C1760", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 1856.4, "10th_percentile": 1856.4, "90th_percentile": 1856.4, "count": "1 through 10" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 570.57, "10th_percentile": 513.23, "90th_percentile": 975.65, "count": "28" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 555.75, "10th_percentile": 518.7, "90th_percentile": 1012.7, "count": "23" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 526.5, "10th_percentile": 513.23, "90th_percentile": 1089.27, "count": "11" } ] } ] }, { "description": "CT-CALCIUM SCORING", "code_information": [ { "code": "75571", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 626.9, "discounted_cash": 119.0, "minimum": 26.53, "maximum": 501.52, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 34.68, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 112.36 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 322.43 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 69.43 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 112.36 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 358.35 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 358.35 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 53.09, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 49.55, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 37.51, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 58.39, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 37.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 119.1 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 157.26 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 37.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 141.82 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 112.36 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 148.36 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 58.39, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 35.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 109.09 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 35.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 35.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 26.53 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 53.09, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "CATH SABER DIALTION 5.0X20", "code_information": [ { "code": "C1725", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 256.5, "10th_percentile": 256.5, "90th_percentile": 288.09, "count": "1 through 10" } ] } ] }, { "description": "SCRW UNI GLENOID PERPHERAL 30", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "ESOPHAGITIS, GASTROENTERITIS AND MISCELLANEOUS DIGESTIVE DISORDERS WITH MCC", "code_information": [ { "code": "391", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 5746.6392, "maximum": 28522.8, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 8856.82 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 12159.19 } ] } ] }, { "description": "ANTISTREPTOLYSIN O TITER", "code_information": [ { "code": "86060", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 152.0, "discounted_cash": 33.0, "minimum": 6.351, "maximum": 143.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7.15, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.3 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 29.49 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 6.35 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.3 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 32.78 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 32.78 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 110.5, "10th_percentile": 110.5, "90th_percentile": 110.5, "count": "1 through 10" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.95, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 10.22, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 7.74, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 7.67, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.92 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 14.42 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.67, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 13.0 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.3 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 13.6 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 7.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.0 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 7.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 11.95 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.95, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "ECHO TRANSESOPHAGEAL (2D) - C8925 - 930001", "code_information": [ { "code": "C8925", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4119.03, "minimum": 312.4142, "maximum": 3295.224, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 312.41, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 1845.02 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 592.31 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 2049.27 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 2049.27 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 478.19, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 446.31, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 337.92, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 526.0, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 334.73, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 334.73, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 526.0, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 318.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 318.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 318.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 580.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 478.19, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "OPIOID ABUSE & DEPENDENCE - SOI : 1", "code_information": [ { "code": "7731", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 2933.8, "maximum": 3109.83, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 3056.23 } ] } ] }, { "description": "VDRL, CSF", "code_information": [ { "code": "86592", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 16.3, "discounted_cash": 14.0, "minimum": 2.445, "maximum": 95.704, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4.18, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.03 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 16.3 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 3.71 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.03 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 16.3 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 16.3 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.41, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 5.98, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 4.53, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.05, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 4.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.39 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.43 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 7.61 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.03 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.96 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.05, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 4.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 5.85 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 4.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 6.98 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.41, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "STENT EXPRESS 7MX27M 75C", "code_information": [ { "code": "C1876", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 3100.8, "10th_percentile": 1880.29, "90th_percentile": 7522.24, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 3482.69, "10th_percentile": 3482.69, "90th_percentile": 3482.69, "count": "1 through 10" } ] } ] }, { "description": "SCREW 4.0X65 SHORT THREAD", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "FLEXOR INTRODUCER 6.0", "code_information": [ { "code": "C1894", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 112.23, "10th_percentile": 28.87, "90th_percentile": 279.68, "count": "37" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 99.92, "10th_percentile": 25.71, "90th_percentile": 152.65, "count": "26" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 94.66, "10th_percentile": 56.02, "90th_percentile": 112.23, "count": "11" } ] } ] }, { "description": "NEONATE BIRTHWT >2499G W OTHER MAJOR PROCEDURE - SOI : 3", "code_information": [ { "code": "6313", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 89264.2, "maximum": 94620.06, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 92989.28 } ] } ] }, { "description": "STENT MULTI VISION 4.0X18MM", "code_information": [ { "code": "C1876", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 3100.8, "10th_percentile": 1880.29, "90th_percentile": 7522.24, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 3482.69, "10th_percentile": 3482.69, "90th_percentile": 3482.69, "count": "1 through 10" } ] } ] }, { "description": "OT EVAL MOD COMPLEX 45 MIN", "code_information": [ { "code": "97166", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 642.32, "discounted_cash": 122.0, "minimum": 79.0, "maximum": 513.856, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 96.07, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 251.98 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 80.89 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 279.87 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 279.87 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 147.05, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 137.24, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 103.91, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 124.61, "10th_percentile": 115.62, "90th_percentile": 137.07, "count": "12" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 161.75, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 102.93, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 102.93, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 24.6, "median_amount": 148.72, "10th_percentile": 148.72, "90th_percentile": 151.05, "count": "1 through 10" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 24.6, "median_amount": 316.04, "10th_percentile": 316.04, "90th_percentile": 316.04, "count": "1 through 10" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 161.75, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 98.03, "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": 19.0, "median_amount": 115.62, "10th_percentile": 115.62, "90th_percentile": 122.04, "count": "1 through 10" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 98.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 98.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 122.04, "10th_percentile": 115.62, "90th_percentile": 137.07, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 79.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 147.05, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "LAP BAND FILL", "code_information": [ { "code": "76000", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 229.13, "discounted_cash": 127.0, "minimum": 27.9009, "maximum": 1014.464, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 95.08, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 229.13 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 129.56 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 27.9 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 229.13 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 143.99 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 143.99 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 145.53, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 135.83, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 102.84, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 160.08, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 101.87, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 229.13 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 229.13 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 101.87, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 229.13 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 229.13 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 229.13 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 160.08, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 97.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 229.13 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 240.94, "10th_percentile": 240.94, "90th_percentile": 240.94, "count": "1 through 10" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 97.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 97.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 188.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 145.53, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "VAC SPONGES SILVER", "code_information": [ { "code": "A6550", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 103.0, "minimum": 15.45, "maximum": 82.4, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 69.5 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 23.9 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 77.19 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 77.19 } ] } ] }, { "description": "CATH VIATRAC 14 6.0X20X135", "code_information": [ { "code": "C1725", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 462.76, "10th_percentile": 256.45, "90th_percentile": 2515.23, "count": "21" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 270.69, "10th_percentile": 106.59, "90th_percentile": 1342.29, "count": "14" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 484.0, "10th_percentile": 143.56, "90th_percentile": 543.74, "count": "1 through 10" } ] } ] }, { "description": "NAIL TFN LONG 11MMX420MM LEFT", "code_information": [ { "code": "c1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "SELECTIVE DEBRIDEMENT ADD 20 S", "code_information": [ { "code": "97598", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 515.21, "discounted_cash": 79.0, "minimum": 10.0311, "maximum": 608.0, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 101.0 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 93.0 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 112.0 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 112.0 } ] } ] }, { "description": "IC THROMBOLYTIC THERAPY", "code_information": [ { "code": "92975", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1066.0, "discounted_cash": 202.0, "minimum": 159.9, "maximum": 852.8, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 526.29 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 280.95 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 585.65 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 585.65 } ] } ] }, { "description": "GAMMA NAIL SCREW 12X110", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "NONSPECIFIC CVA & PRECEREBRAL OCCLUSION WO INFARCT - SOI : 2", "code_information": [ { "code": "0462", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 10793.57, "maximum": 11441.18, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 11243.99 } ] } ] }, { "description": "TRACHEOSTOMY W MV 96+ HOURS W EXTENSIVE PROCEDURE - SOI : 3", "code_information": [ { "code": "0043", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 157261.2, "maximum": 166696.87, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 163823.86 } ] } ] }, { "description": "CK-MM/CREATINE ISOFORMS(REF)", "code_information": [ { "code": "82554", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 147.0, "discounted_cash": 27.0, "minimum": 10.3269, "maximum": 117.6, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11.63, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.75 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 47.95 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 10.33 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.75 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 53.3 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 53.3 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17.81, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 16.62, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 12.58, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.59, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.46, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.75 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.44 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.46, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 21.14 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.75 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.11 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.59, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 11.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.26 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 11.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 19.43 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.81, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "14.3.3 eta, Rheumatoid Arthrit", "code_information": [ { "code": "83520", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 90.0, "discounted_cash": 48.0, "minimum": 5.0445, "maximum": 585.36, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 16.92, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.37 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 69.77 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 15.02 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.37 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 77.54 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 77.54 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 121.41, "10th_percentile": 121.41, "90th_percentile": 121.41, "count": "1 through 10" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 25.91, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 24.18, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 18.31, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 28.5, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 18.13, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.83 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 34.11 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.13, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 30.76 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.37 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 32.18 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 28.5, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.66 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 12.78, "10th_percentile": 12.78, "90th_percentile": 12.78, "count": "1 through 10" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 21.19 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 25.91, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "FOOT & TOE PROCEDURES - SOI : 3", "code_information": [ { "code": "3143", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 20295.96, "maximum": 21513.71, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 21142.93 } ] } ] }, { "description": "EXTERNAL HEART ASSIST SYSTEMS- SOI : 1", "code_information": [ { "code": "1781", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 70527.78, "maximum": 74759.45, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 73470.98 } ] } ] }, { "description": "DNA Analysis/MTHFR", "code_information": [ { "code": "81291", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 668.25, "discounted_cash": 126.0, "minimum": 56.8458, "maximum": 534.6, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 64.03, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 92.21 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 263.97 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 56.85 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 92.21 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 293.38 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 293.38 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 98.01, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 91.48, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 69.26, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 107.81, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 68.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 97.74 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 129.05 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 68.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 116.38 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 92.21 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 121.75 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 107.81, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 65.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 89.52 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 65.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 65.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 71.46 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 98.01, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "SKIN DEBRIDEMENT WITH MCC", "code_information": [ { "code": "570", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 13098.0334, "maximum": 59297.4, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 28573.2 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 28196.33 } ] } ] }, { "description": "EMBOLECTOMY CATHETER 6FR", "code_information": [ { "code": "C1757", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 789.75, "10th_percentile": 416.2, "90th_percentile": 947.7, "count": "1 through 10" } ] } ] }, { "description": "HLTH BEHAVIOR ASMT/REASMT(914)", "code_information": [ { "code": "96156", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 392.7, "discounted_cash": 74.0, "minimum": 40.4838, "maximum": 314.16, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 40.48, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 212.84 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 68.33 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 236.41 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 236.41 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 61.97, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 57.83, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 43.79, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 68.16, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 43.38, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 43.38, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 68.16, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 41.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 41.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 41.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 61.97, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "HEP B CORE AB TOTAL(REF) - 86704 - 800211", "code_information": [ { "code": "86704", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 66.28, "discounted_cash": 12.0, "minimum": 9.942, "maximum": 54.1, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11.81, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.01 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 48.68 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 10.48 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.01 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 54.1 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 54.1 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.08, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 12.77, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.88, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.03 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.8 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 21.46 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.01 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.45 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.88, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.51 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 19.73 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.08, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "DEGENERATIVE NERVOUS SYSTEM DISORDERS WITHOUT MCC", "code_information": [ { "code": "057", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 12420.9172, "maximum": 28522.8, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 13817.6 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 12420.92 } ] } ] }, { "description": "LAPAROSCOPY TUBAL CAUTERY", "code_information": [ { "code": "58670", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 18750.0, "discounted_cash": 3562.0, "minimum": 2409.3006, "maximum": 15000.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2409.3, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 6428.83 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 3431.93 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 7153.89 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 7153.89 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3687.71, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 3441.86, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 2605.98, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4056.48, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2581.39, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2581.39, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4056.48, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2458.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2458.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 2458.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3687.71, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "PLATE WRIST DISTAL RADIUS 2.4", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "SCRW CANN COMP HDLESS 3.5 46MM", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "CATH NANOCROSS EV3 4.0X40MM", "code_information": [ { "code": "C1725", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 256.5, "10th_percentile": 256.5, "90th_percentile": 288.09, "count": "1 through 10" } ] } ] }, { "description": "Rerepair ing hernia blocked", "code_information": [ { "code": "49521", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6628.13, "discounted_cash": 1259.0, "minimum": 994.2195, "maximum": 5302.504, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2580.0, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 4135.42 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 2207.63 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 4601.82 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 4601.82 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3948.98, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 3685.71, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 2790.61, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4343.87, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2764.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2764.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4343.87, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 2632.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2632.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 2632.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3948.98, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "FRACTURE OF FEMUR - SOI : 4", "code_information": [ { "code": "3404", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 28684.8, "maximum": 30405.89, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 29881.84 } ] } ] }, { "description": "BENADRYL - 00641037625", "drug_information": { "unit": 1.0, "type": "ML" }, "code_information": [ { "code": "00641037625", "type": "NDC" }, { "code": "J1200", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 6.36, "10th_percentile": 5.24, "90th_percentile": 6.36, "count": "1 through 10" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1.68, "10th_percentile": 1.68, "90th_percentile": 2.0, "count": "11" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 24.6, "median_amount": 1.16, "10th_percentile": 0.91, "90th_percentile": 1.16, "count": "17" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1.78, "10th_percentile": 1.78, "90th_percentile": 3.56, "count": "1 through 10" } ] } ] }, { "description": "CATH BALLOON NC EUPHORA 3.5X8M", "code_information": [ { "code": "C1725", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 462.76, "10th_percentile": 256.45, "90th_percentile": 2515.23, "count": "21" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 270.69, "10th_percentile": 106.59, "90th_percentile": 1342.29, "count": "14" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 484.0, "10th_percentile": 143.56, "90th_percentile": 543.74, "count": "1 through 10" } ] } ] }, { "description": "NON-MALIGNANT BREAST DISORDERS WITHOUT CCMCC", "code_information": [ { "code": "601", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 3175.3368, "maximum": 18765.0, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 4303.99 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 5800.14 } ] } ] }, { "description": "DRESSING VERSATEL 3X4 CON LAY", "code_information": [ { "code": "A6206", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 8.02, "10th_percentile": 8.02, "90th_percentile": 16.04, "count": "1 through 10" } ] } ] }, { "description": "Treat humerus fracture - 24579 - OR36024579", "code_information": [ { "code": "24579", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7953.75, "discounted_cash": 1511.0, "minimum": 1193.0625, "maximum": 7953.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5116.57, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 7953.75 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 7953.75 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 7953.75 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 7953.75 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7831.49, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 7309.39, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 5534.25, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7953.75, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5482.04, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5482.04, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7953.75, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 5220.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5220.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 5220.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7831.49, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "CAT SPRINTER LEGEND 2.5X10", "code_information": [ { "code": "C1725", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 462.76, "10th_percentile": 256.45, "90th_percentile": 2515.23, "count": "21" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 270.69, "10th_percentile": 106.59, "90th_percentile": 1342.29, "count": "14" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 484.0, "10th_percentile": 143.56, "90th_percentile": 543.74, "count": "1 through 10" } ] } ] }, { "description": "CATH BALLOON POWERFLEX 6X10", "code_information": [ { "code": "C1725", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 462.76, "10th_percentile": 256.45, "90th_percentile": 2515.23, "count": "21" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 270.69, "10th_percentile": 106.59, "90th_percentile": 1342.29, "count": "14" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 484.0, "10th_percentile": 143.56, "90th_percentile": 543.74, "count": "1 through 10" } ] } ] }, { "description": "SELF TAPPING LCK SCR 3.5", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "VARICELLA ZOSTER VIRUS DNA PCR - 87798 - 800615", "code_information": [ { "code": "87798", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 250.0, "discounted_cash": 33.0, "minimum": 7.5, "maximum": 749.52, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 34.39, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 49.51 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 141.76 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 30.53 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 49.51 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 157.55 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 157.55 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 52.64, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 49.13, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 37.2, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 57.9, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 36.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 52.48 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 69.3 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 62.49 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 49.51 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 65.38 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 57.9, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 48.07 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 57.44 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 52.64, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "CANC SCREW 2332-30", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "LEAD PACING TENDRIL 46CM", "code_information": [ { "code": "C1898", "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": 19.0, "median_amount": 844.74, "10th_percentile": 844.74, "90th_percentile": 844.74, "count": "1 through 10" } ] } ] }, { "description": "LEAD PCNG IS-1 PASSIVE58", "code_information": [ { "code": "C1898", "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": 19.0, "median_amount": 844.74, "10th_percentile": 844.74, "90th_percentile": 844.74, "count": "1 through 10" } ] } ] }, { "description": "SCREW LAG LG 55MM27", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "GUIDE CATHETER 6 FR AR 1 SH", "code_information": [ { "code": "C1887", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 115.24, "10th_percentile": 81.0, "90th_percentile": 503.66, "count": "23" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 156.51, "10th_percentile": 102.6, "90th_percentile": 572.45, "count": "11" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 129.36, "10th_percentile": 24.35, "90th_percentile": 512.12, "count": "1 through 10" } ] } ] }, { "description": "CORT SCREW 2323-10", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "BILATERAL OR MULTIPLE MAJOR JOINT PROCEDURES OF LOWER EXTREMITY WITH MCC", "code_information": [ { "code": "461", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 28059.8916, "maximum": 58250.5, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 58250.5 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 52949.0 } ] } ] }, { "description": "STENT RESOLUTE INTEGRITY 4X22M", "code_information": [ { "code": "C1876", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 3100.8, "10th_percentile": 1880.29, "90th_percentile": 7522.24, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 3482.69, "10th_percentile": 3482.69, "90th_percentile": 3482.69, "count": "1 through 10" } ] } ] }, { "description": "SCREW CANCELLOUS BONE 4", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "CATH SWAN GANZ 7 FR 110 CM", "code_information": [ { "code": "C1725", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 462.76, "10th_percentile": 256.45, "90th_percentile": 2515.23, "count": "21" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 270.69, "10th_percentile": 106.59, "90th_percentile": 1342.29, "count": "14" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 484.0, "10th_percentile": 143.56, "90th_percentile": 543.74, "count": "1 through 10" } ] } ] }, { "description": "THYROID, PARATHYROID AND THYROGLOSSAL PROCEDURES WITH CC", "code_information": [ { "code": "626", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 7630.3214, "maximum": 17115.0, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 17115.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 14374.75 } ] } ] }, { "description": "APPLICATION OF FINGER SPLINT", "code_information": [ { "code": "29130", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 610.93, "discounted_cash": 116.0, "minimum": 39.06, "maximum": 488.744, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 53.02, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 73.16 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 39.06 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 81.41 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 81.41 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 81.15, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 75.74, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 57.35, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 95.7, "10th_percentile": 95.7, "90th_percentile": 130.37, "count": "1 through 10" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 89.27, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 56.81, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 56.81, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "percent of total billed charges", "standard_charge_percentage": 24.6, "median_amount": 122.19, "10th_percentile": 114.8, "90th_percentile": 156.4, "count": "1 through 10" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 89.27, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 54.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 54.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 54.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 81.15, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "CAS SPHERES PLUS ORTHO", "code_information": [ { "code": "C1776", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 4588.1, "10th_percentile": 1617.12, "90th_percentile": 11630.3, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 9120.0, "10th_percentile": 9120.0, "90th_percentile": 9120.0, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 8640.0, "10th_percentile": 8640.0, "90th_percentile": 9120.0, "count": "1 through 10" } ] } ] }, { "description": "POST-OPERATIVE, POST-TRAUMATIC, OTHER DEVICE INFECTIONS - SOI : 2", "code_information": [ { "code": "7212", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 10505.15, "maximum": 11135.46, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 10943.54 } ] } ] }, { "description": "VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITH MCC", "code_information": [ { "code": "805", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 3898.0, "maximum": 21016.8, "payers_information": [ { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "case rate", "standard_charge_dollar": 6500.0, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 4941.08 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 3898.0 } ] } ] }, { "description": "NAIL TFN LONG 11MMX340 RIGHT", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "RESPIRATORY SYSTEM DIAGNOSIS W VENTILATOR SUPPORT 96+ HOURS - SOI : 4", "code_information": [ { "code": "1304", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 94459.48, "maximum": 100127.05, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 98401.36 } ] } ] }, { "description": "URINARY STONES & ACQUIRED UPPER URINARY TRACT OBSTRUCTION - SOI : 2", "code_information": [ { "code": "4652", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 8901.69, "maximum": 9435.79, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 9273.16 } ] } ] }, { "description": "DEGENERATIVE NERVOUS SYSTEM DISORDERS EXC MULT SCLEROSIS - SOI : 3", "code_information": [ { "code": "0423", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 19445.04, "maximum": 20611.74, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 20256.5 } ] } ] }, { "description": "STENT COR XIENCE SIERA 2.5X28", "code_information": [ { "code": "C1874", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 4258.8, "10th_percentile": 4258.8, "90th_percentile": 4420.0, "count": "1 through 10" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1456.46, "10th_percentile": 975.0, "90th_percentile": 4680.0, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1444.95, "10th_percentile": 1444.95, "90th_percentile": 1444.95, "count": "1 through 10" } ] } ] }, { "description": "SCRW SLF TPING SD/42 5.0 VAL", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "SCREW TI LOCKING 4X36 STERILE", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "SCREW ISOTAC CANFLEX", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "PERIPHERAL, CRANIAL & AUTONOMIC NERVE DISORDERS - SOI : 2", "code_information": [ { "code": "0482", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 7876.0, "maximum": 8348.56, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 8204.67 } ] } ] }, { "description": "RESTRATA 10.0 CM X 12.5 CM", "code_information": [ { "code": "A2007", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 3040.95, "10th_percentile": 3040.95, "90th_percentile": 5868.5, "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", "minimum": 26318.9056, "maximum": 78062.4, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 43509.3 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 46058.82 } ] } ] }, { "description": "BACTERIAL & TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM - SOI : 1", "code_information": [ { "code": "0491", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 13948.93, "maximum": 14785.87, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 14531.04 } ] } ] }, { "description": "ANGIOSCULPT RX PTCA TAPER 2X6", "code_information": [ { "code": "C1725", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 462.76, "10th_percentile": 256.45, "90th_percentile": 2515.23, "count": "21" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 270.69, "10th_percentile": 106.59, "90th_percentile": 1342.29, "count": "14" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 484.0, "10th_percentile": 143.56, "90th_percentile": 543.74, "count": "1 through 10" } ] } ] }, { "description": "GAMMA NAIL SCREW 6.28X35", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "SIMULTANEOUS PANCREAS AND KIDNEY TRANSPLANT WITH HEMODIALYSIS", "code_information": [ { "code": "019", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 49950.0, "maximum": 83316.6, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 75247.5 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 68399.41 } ] } ] }, { "description": "MAJOR MALE PELVIC PROCEDURES - SOI : 2", "code_information": [ { "code": "4802", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 29892.89, "maximum": 31686.47, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 31140.35 } ] } ] }, { "description": "STENT XIENCE ALPINE 2.75X8MM", "code_information": [ { "code": "C1876", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 3100.8, "10th_percentile": 1880.29, "90th_percentile": 7522.24, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 3482.69, "10th_percentile": 3482.69, "90th_percentile": 3482.69, "count": "1 through 10" } ] } ] }, { "description": "COMPLEMENT C3", "code_information": [ { "code": "86160", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 202.13, "discounted_cash": 38.0, "minimum": 10.44, "maximum": 161.704, "payers_information": [ { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.6, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.95 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 23.7 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.6, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 21.37 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.93 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.36 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.8, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.44 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 38.4, "10th_percentile": 38.4, "90th_percentile": 38.4, "count": "1 through 10" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 12.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 19.66 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.0, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11.76, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.93 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 48.48 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 10.44 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.93 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 53.88 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 53.88 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.0, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 16.8, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 12.72, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 76.81, "10th_percentile": 76.81, "90th_percentile": 76.81, "count": "1 through 10" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.8, "additional_payer_notes": "165.00% of Medicare Rates" } ] } ] }, { "description": "ORTHO HALF PIN 5X40MM", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "ANTIEPILEPTICS NOS 1-3 - 80339 - 851065", "code_information": [ { "code": "80339", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 235.53, "discounted_cash": 44.0, "minimum": 6.85, "maximum": 188.424, "payers_information": [ { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.06 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.06 }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.48 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.87 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 8.91 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.06 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.32 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.85 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 24.19 } ] } ] }, { "description": "CRTX SCRW 4.5MM X 22MM", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "US RT BREAST", "code_information": [ { "code": "76641", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 778.75, "discounted_cash": 147.0, "minimum": 41.6598, "maximum": 838.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 41.66, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 135.95 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 452.8 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 97.51 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 135.95 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 503.24 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 503.24 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 63.77, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 59.51, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 45.06, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 70.14, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 44.64, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 144.11 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 190.28 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 44.64, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 171.59 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 135.95 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 179.51 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 70.14, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 42.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 131.99 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 42.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 42.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 109.99 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 63.77, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "CATH EV3 EVERCROSS 7X150MM", "code_information": [ { "code": "C1725", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 462.76, "10th_percentile": 256.45, "90th_percentile": 2515.23, "count": "21" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 270.69, "10th_percentile": 106.59, "90th_percentile": 1342.29, "count": "14" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 484.0, "10th_percentile": 143.56, "90th_percentile": 543.74, "count": "1 through 10" } ] } ] }, { "description": "I&D OF VULVA ABSCESS", "code_information": [ { "code": "56405", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1365.0, "discounted_cash": 155.0, "minimum": 49.71, "maximum": 1092.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 121.44, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 67.21 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 49.71 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 74.91 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 74.91 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 185.88, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 173.49, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 131.36, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 204.47, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 130.12, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 130.12, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 204.47, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 123.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 123.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 123.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 185.88, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "MALIGNANCY OF HEPATOBILIARY SYSTEM & PANCREAS - SOI : 3", "code_information": [ { "code": "2813", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 14648.96, "maximum": 15527.9, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 15260.27 } ] } ] }, { "description": "BK VIRUS", "code_information": [ { "code": "87799", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 720.0, "discounted_cash": 71.0, "minimum": 37.2708, "maximum": 576.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 41.98, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 60.45 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 173.07 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 37.27 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 60.45 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 192.35 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 192.35 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 64.26, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 59.98, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 45.41, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 70.69, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 44.98, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 64.08 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 84.61 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 44.98, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 76.3 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 60.45 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 79.82 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 70.69, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "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": "fee schedule", "standard_charge_dollar": 58.69 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 42.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 42.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 70.13 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 64.26, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "KIDNEY AND URETER PROCEDURES FOR NEOPLASM WITH MCC", "code_information": [ { "code": "656", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 15154.8906, "maximum": 38280.6, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 26060.8 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 30523.09 } ] } ] }, { "description": "ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH MCC", "code_information": [ { "code": "280", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 7509.7916, "maximum": 30774.6, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 13027.4 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 15378.51 } ] } ] }, { "description": "HLA DQB1 High Resolution", "code_information": [ { "code": "81382", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1478.3, "discounted_cash": 300.0, "minimum": 107.6016, "maximum": 1264.12, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 121.21, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 174.52 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 499.67 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 107.6 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 174.52 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 555.32 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 555.32 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 185.52, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 173.15, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 131.1, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 204.07, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 129.86, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 184.99 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 244.26 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 129.86, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 220.27 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 174.52 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 230.44 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 204.07, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 123.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 169.44 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 123.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 123.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 202.48 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 185.52, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "ORGANIC MENTAL HEALTH DISTURBANCES - SOI : 2", "code_information": [ { "code": "7572", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 12275.75, "maximum": 13012.29, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 12788.03 } ] } ] }, { "description": "TRANSURETHRAL PROSTATECTOMY WITHOUT CCMCC", "code_information": [ { "code": "714", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 4287.813, "maximum": 11259.0, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 8920.11 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 10137.29 } ] } ] }, { "description": "Deb skin bone at fx site", "code_information": [ { "code": "11012", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 13125.0, "discounted_cash": 2493.0, "minimum": 1157.6054, "maximum": 10500.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1157.61, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 3084.12 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 1646.41 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 3431.96 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 3431.96 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1771.85, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 1653.72, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 1252.1, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1949.03, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1240.29, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1240.29, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1949.03, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 1181.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1181.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 1181.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1771.85, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "SCREW COMPRESSION SHORT 3X16", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "LIQUID BASED PAP >21", "code_information": [ { "code": "88142", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 27.0, "discounted_cash": 5.0, "minimum": 4.05, "maximum": 27.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.85, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.0 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 27.0 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 17.63 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.0 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 27.0 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 27.0 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 27.0, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 27.0, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 21.48, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 27.0, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 21.27, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.0 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.0 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.27, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 27.0 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.0 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 27.0 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 27.0, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "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": "fee schedule", "standard_charge_dollar": 27.0 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 20.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 20.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 27.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 27.0, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "TX SUPRFCL WND DEHSN W/PACKING", "code_information": [ { "code": "12021", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2089.56, "discounted_cash": 397.0, "minimum": 162.0038, "maximum": 1671.648, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 162.0, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 424.95 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 226.85 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 472.87 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 472.87 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 247.97, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 231.43, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 175.23, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 272.76, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 173.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 272.76, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 165.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 165.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 165.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 247.97, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "2.4MM CORTEX SCREW 14MM", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "INTIAL PUSH OF A DRUG", "code_information": [ { "code": "96374", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 258.0, "discounted_cash": 189.0, "minimum": 34.4868, "maximum": 998.59, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 84.76, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 107.42 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 34.49 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 119.32 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 119.32 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 129.74, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 121.09, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 91.68, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 189.73, "10th_percentile": 127.26, "90th_percentile": 998.59, "count": "67" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 142.71, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 90.81, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 90.81, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 142.71, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 86.49, "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": 19.0, "median_amount": 189.73, "10th_percentile": 189.73, "90th_percentile": 189.73, "count": "15" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 86.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 86.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 189.73, "10th_percentile": 54.38, "90th_percentile": 213.1, "count": "12" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 258.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 129.74, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "CATH BLNDIL 3MM 30MM RX F LL", "code_information": [ { "code": "C1725", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 462.76, "10th_percentile": 256.45, "90th_percentile": 2515.23, "count": "21" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 270.69, "10th_percentile": 106.59, "90th_percentile": 1342.29, "count": "14" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 484.0, "10th_percentile": 143.56, "90th_percentile": 543.74, "count": "1 through 10" } ] } ] }, { "description": "XR FOOT 3+V-RT", "code_information": [ { "code": "73630", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 539.99, "discounted_cash": 226.0, "minimum": 34.6822, "maximum": 952.8, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 34.68, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 112.36 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 322.43 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 69.43 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 112.36 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 358.35 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 358.35 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 367.19, "10th_percentile": 302.39, "90th_percentile": 367.19, "count": "23" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 53.09, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 49.55, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 37.51, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 162.0, "10th_percentile": 147.27, "90th_percentile": 267.52, "count": "13" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 102.6, "10th_percentile": 97.2, "90th_percentile": 115.23, "count": "48" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 58.39, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 37.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 119.1 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 157.26 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 37.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "QTC Medical Group", "plan_name": "QTC Medical Group", "methodology": "fee schedule", "standard_charge_dollar": 51.82 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 141.82 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 112.36 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 148.36 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 58.39, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 35.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 109.09 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 102.6, "10th_percentile": 102.6, "90th_percentile": 102.6, "count": "32" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 35.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 35.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 102.6, "10th_percentile": 51.75, "90th_percentile": 115.23, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 68.82 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 53.09, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "BG OTH(AnyCmbo.w/Calc. O2SATA)", "code_information": [ { "code": "82803", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 451.53, "discounted_cash": 85.0, "minimum": 22.6809, "maximum": 361.224, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 25.55, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 36.79 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 105.32 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 22.68 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 36.79 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 117.05 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 117.05 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 252.86, "10th_percentile": 252.86, "90th_percentile": 279.13, "count": "1 through 10" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 39.11, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 36.5, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 27.63, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 85.79, "10th_percentile": 65.47, "90th_percentile": 96.36, "count": "49" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 43.02, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 27.37, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 39.0 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 51.49 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.37, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 46.44 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 36.79 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 48.58 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 43.02, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 26.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 35.72 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 85.79, "10th_percentile": 85.79, "90th_percentile": 85.79, "count": "36" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 26.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 26.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 85.79, "10th_percentile": 81.28, "90th_percentile": 96.36, "count": "21" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 31.68 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 39.11, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "WOUND E-STEM SUPERVISED", "code_information": [ { "code": "G0281", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 96.0, "minimum": 11.1622, "maximum": 116.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 96.0 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 93.0 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 96.0 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 96.0 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17.09, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 15.95, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 12.07, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.79, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 11.96, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.96, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.79, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 11.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 11.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.09, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "SYNCOPE & COLLAPSE - SOI : 4", "code_information": [ { "code": "2044", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 29827.95, "maximum": 31617.63, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 31072.7 } ] } ] }, { "description": "STENT INTEGRITY RX 2.25X22MM", "code_information": [ { "code": "C1874", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 4258.8, "10th_percentile": 4258.8, "90th_percentile": 4420.0, "count": "1 through 10" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1456.46, "10th_percentile": 975.0, "90th_percentile": 4680.0, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1444.95, "10th_percentile": 1444.95, "90th_percentile": 1444.95, "count": "1 through 10" } ] } ] }, { "description": "STEM POROUS COATED SIZE5", "code_information": [ { "code": "C1776", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 4588.1, "10th_percentile": 1617.12, "90th_percentile": 11630.3, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 9120.0, "10th_percentile": 9120.0, "90th_percentile": 9120.0, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 8640.0, "10th_percentile": 8640.0, "90th_percentile": 9120.0, "count": "1 through 10" } ] } ] }, { "description": "RESPIRATORY MALIGNANCY - SOI : 3", "code_information": [ { "code": "1363", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 20301.69, "maximum": 21519.79, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 21148.9 } ] } ] }, { "description": "SPINAL PROCEDURES WITH CC OR SPINAL NEUROSTIMULATORS", "code_information": [ { "code": "029", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 21150.0, "maximum": 35278.2, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 23696.3 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 32707.01 } ] } ] }, { "description": "OTHER INJURY, POISONING AND TOXIC EFFECT DIAGNOSES WITHOUT MCC", "code_information": [ { "code": "923", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 4296.5872, "maximum": 21767.4, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 4437.39 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 9756.69 } ] } ] }, { "description": "XR ANKLE 3+V-RT", "code_information": [ { "code": "73610", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 549.29, "discounted_cash": 104.0, "minimum": 34.6822, "maximum": 439.432, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 75.0, "median_amount": 411.97, "10th_percentile": 411.97, "90th_percentile": 411.97, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 34.68, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 112.36 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 322.43 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 69.43 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 112.36 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 358.35 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 358.35 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 339.56, "10th_percentile": 307.6, "90th_percentile": 373.52, "count": "21" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 53.09, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 49.55, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 37.51, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 164.79, "10th_percentile": 149.81, "90th_percentile": 326.78, "count": "14" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 106.56, "10th_percentile": 98.87, "90th_percentile": 117.22, "count": "42" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 58.39, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 37.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 119.1 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 157.26 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 37.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "QTC Medical Group", "plan_name": "QTC Medical Group", "methodology": "fee schedule", "standard_charge_dollar": 51.82 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 141.82 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 112.36 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 148.36 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 58.39, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 35.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 109.09 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 104.37, "10th_percentile": 104.37, "90th_percentile": 104.37, "count": "28" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 35.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 35.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 104.37, "10th_percentile": 104.37, "90th_percentile": 117.22, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 68.82 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 53.09, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "CATH DILATION SABER 2.5X20X150", "code_information": [ { "code": "C1725", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 462.76, "10th_percentile": 256.45, "90th_percentile": 2515.23, "count": "21" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 270.69, "10th_percentile": 106.59, "90th_percentile": 1342.29, "count": "14" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 484.0, "10th_percentile": 143.56, "90th_percentile": 543.74, "count": "1 through 10" } ] } ] }, { "description": "Remove limb nerve lesion", "code_information": [ { "code": "64782", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3535.0, "discounted_cash": 671.0, "minimum": 530.25, "maximum": 2828.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 778.21, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "case rate", "standard_charge_dollar": 2286.74 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "case rate", "standard_charge_dollar": 1220.74 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "case rate", "standard_charge_dollar": 2544.64 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "case rate", "standard_charge_dollar": 2544.64 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1191.14, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 1111.73, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 841.74, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1310.25, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 833.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 833.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1310.25, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 794.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 794.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 794.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1191.14, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "ANTI-PR3 ANTIBODIES", "code_information": [ { "code": "83516", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 545.0, "discounted_cash": 32.0, "minimum": 4.4625, "maximum": 436.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11.3, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.26 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 46.58 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 10.03 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.26 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 51.77 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 51.77 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 94.5, "10th_percentile": 94.5, "90th_percentile": 114.75, "count": "1 through 10" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17.3, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 16.14, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 12.22, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 30.38, "10th_percentile": 5.36, "90th_percentile": 96.03, "count": "1 through 10" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.02, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.24 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 22.76 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 20.53 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 16.26 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 21.47 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.02, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "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": "fee schedule", "standard_charge_dollar": 15.79 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 5.65, "10th_percentile": 5.65, "90th_percentile": 5.65, "count": "1 through 10" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 18.89 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.3, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "MAGNESIUM 2 GRAM/50ML", "drug_information": { "unit": 50.0, "type": "ML" }, "code_information": [ { "code": "00409672924", "type": "NDC" }, { "code": "J3475", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 134.4, "10th_percentile": 134.4, "90th_percentile": 163.2, "count": "1 through 10" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 22.8, "10th_percentile": 21.6, "90th_percentile": 51.22, "count": "33" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 22.8, "10th_percentile": 22.8, "90th_percentile": 45.6, "count": "13" } ] } ] }, { "description": "STENT XIENCE ALPINE 4.0X23MM", "code_information": [ { "code": "C1874", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 4258.8, "10th_percentile": 4258.8, "90th_percentile": 4420.0, "count": "1 through 10" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1456.46, "10th_percentile": 975.0, "90th_percentile": 4680.0, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1444.95, "10th_percentile": 1444.95, "90th_percentile": 1444.95, "count": "1 through 10" } ] } ] }, { "description": "BONE SCREW 4MM X 5MM X28MM", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "SCREW CORTEX 3.5X30MM", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "SELINIUM SERUM", "code_information": [ { "code": "84255", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 142.55, "discounted_cash": 27.0, "minimum": 21.3825, "maximum": 114.63, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 25.02, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 36.03 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 103.14 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 22.21 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 36.03 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 114.63 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 114.63 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 96.93, "10th_percentile": 96.93, "90th_percentile": 96.93, "count": "1 through 10" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 38.3, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 35.74, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 27.06, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 42.12, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 26.81, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 38.19 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 50.43 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.81, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 45.47 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 36.03 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 47.57 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 42.12, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 25.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 34.98 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 25.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 25.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 41.8 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 38.3, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "SCREW METAPHYSEAL 2.7X30 MM", "code_information": [ { "code": "C1713", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1323.2, "10th_percentile": 849.21, "90th_percentile": 3395.2, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1007.76, "10th_percentile": 1007.76, "90th_percentile": 3206.06, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1071.72, "10th_percentile": 637.29, "90th_percentile": 3978.81, "count": "1 through 10" } ] } ] }, { "description": "MALFUNCTION, REACTION, COMPLIC OF GENITOURINARY DEVICE OR PROC - SOI : 1", "code_information": [ { "code": "4661", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 6557.13, "maximum": 6950.55, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "UBH Medicaid", "methodology": "case rate", "standard_charge_dollar": 6830.76 } ] } ] }, { "description": "PULM MANIPULATION INIT", "code_information": [ { "code": "94667", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 672.03, "discounted_cash": 127.0, "minimum": 53.018, "maximum": 537.624, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 53.02, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 295.47 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 94.86 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 328.18 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 328.18 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 81.15, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 75.74, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 57.35, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 89.27, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 56.81, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 56.81, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 89.27, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 54.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 54.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 54.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 168.0 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 81.15, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "THC CONFIRM(REF) - G0480 - 800164", "code_information": [ { "code": "G0480", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 629.37, "minimum": 18.8805, "maximum": 513.79, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 112.14, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 161.47 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 462.3 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 99.55 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 161.47 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 513.79 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 513.79 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 373.72, "10th_percentile": 373.72, "90th_percentile": 373.72, "count": "1 through 10" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 171.65, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 160.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 121.3, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 52.01, "10th_percentile": 37.62, "90th_percentile": 119.58, "count": "1 through 10" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 188.81, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 120.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 171.16 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 226.0 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 120.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 203.8 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 161.47 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 213.21 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 188.81, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 156.77 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 37.62, "10th_percentile": 22.8, "90th_percentile": 114.43, "count": "1 through 10" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 42.25, "10th_percentile": 42.25, "90th_percentile": 42.25, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 95.93 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 171.65, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "MRI BILAT LOWER EXT NON-JOINT", "code_information": [ { "code": "73718", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3941.0, "discounted_cash": 822.0, "minimum": 95.0796, "maximum": 3465.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 95.08, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 303.0 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 941.48 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 202.74 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 303.0 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1046.35 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 1046.35 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 145.53, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 135.83, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 102.84, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 160.08, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 101.87, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 321.17 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 424.08 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 101.87, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 382.42 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 303.0 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 400.07 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 160.08, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 97.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 294.17 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 97.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 97.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 353.74 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 145.53, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "CT ABD/PELVIS W/O CONTR", "code_information": [ { "code": "74176", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5467.0, "discounted_cash": 1038.0, "minimum": 95.0796, "maximum": 4373.6, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 75.0, "median_amount": 4100.25, "10th_percentile": 226.59, "90th_percentile": 4100.25, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 95.08, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "Amerigroup", "plan_name": "Amerigroup Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 303.0 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 941.48 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 202.74 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 303.0 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 1046.35 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 1046.35 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 68.0, "median_amount": 3379.6, "10th_percentile": 3061.52, "90th_percentile": 3717.56, "count": "17" }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 145.53, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 135.83, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 102.84, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 1640.1, "10th_percentile": 1491.0, "90th_percentile": 1640.11, "count": "1 through 10" }, { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1038.73, "10th_percentile": 984.06, "90th_percentile": 1166.66, "count": "52" }, { "payer_name": "Molina", "plan_name": "Molina Insurance Exchange", "methodology": "fee schedule", "standard_charge_dollar": 160.08, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 101.87, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 321.17 }, { "payer_name": "Molina", "plan_name": "Molina STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 424.08 }, { "payer_name": "PROVIDER PARTNERS HEALTH PLAN", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 101.87, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR KIDS", "methodology": "fee schedule", "standard_charge_dollar": 382.42 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 303.0 }, { "payer_name": "Superior Health Plan", "plan_name": "Superior Health Plan STAR PLUS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 400.07 }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Commercial", "methodology": "fee schedule", "standard_charge_dollar": 160.08, "additional_payer_notes": "165.00% of Medicare Rates" }, { "payer_name": "Texas Blue Bonnet Health Plan", "plan_name": "Texas Blue Bonnet Health Plan Medicare Advantage", "methodology": "fee schedule", "standard_charge_dollar": 97.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 294.17 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1038.73, "10th_percentile": 1038.73, "90th_percentile": 1038.73, "count": "44" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 97.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Triwest ( BCBS )", "plan_name": "Triwest BCBS", "methodology": "fee schedule", "standard_charge_dollar": 97.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 1038.73, "10th_percentile": 984.06, "90th_percentile": 1166.66, "count": "19" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 290.15 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Exchange", "methodology": "fee schedule", "standard_charge_dollar": 145.53, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "INSERT TIBIAL FIXED SZ 2 17MM", "code_information": [ { "code": "C1776", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "payers_information": [ { "payer_name": "Managed Medicare - CAH", "plan_name": "Managed Medicare - CAH", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 4588.1, "10th_percentile": 1617.12, "90th_percentile": 11630.3, "count": "1 through 10" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 9120.0, "10th_percentile": 9120.0, "90th_percentile": 9120.0, "count": "1 through 10" }, { "payer_name": "United Healthcare", "plan_name": "UHC - Medicare Advantage", "methodology": "percent of total billed charges", "standard_charge_percentage": 19.0, "median_amount": 8640.0, "10th_percentile": 8640.0, "90th_percentile": 9120.0, "count": "1 through 10" } ] } ] }, { "description": "INFECTIONS, FEMALE REPRODUCTIVE SYSTEM WITH CC", "code_information": [ { "code": "758", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 4465.606, "maximum": 26271.0, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 6168.22 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "case rate", "standard_charge_dollar": 9385.67 } ] } ] }, { "description": "Administration Fee for Flu Vac - G0008 - 006017", "code_information": [ { "code": "G0008", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 111.09, "minimum": 16.6635, "maximum": 246.912, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry FKA Aetna Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.66, "additional_payer_notes": "98.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS HMO", "methodology": "fee schedule", "standard_charge_dollar": 64.47 }, { "payer_name": "BCBS", "plan_name": "BCBS HMO Advantage", "methodology": "fee schedule", "standard_charge_dollar": 20.7 }, { "payer_name": "BCBS", "plan_name": "BCBS PPO", "methodology": "fee schedule", "standard_charge_dollar": 71.61 }, { "payer_name": "BCBS", "plan_name": "BCBS Traditional", "methodology": "fee schedule", "standard_charge_dollar": 71.61 }, { "payer_name": "Corporate Remedies (WC)", "plan_name": "Corporate Remedies Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 28.56, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare", "methodology": "fee schedule", "standard_charge_dollar": 26.66, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Imperial Insurance Companies", "plan_name": "Imperial Insurance Companies", "methodology": "fee schedule", "standard_charge_dollar": 20.18, "additional_payer_notes": "106.00% of Med