{ "hospital_name": "Holy Family Medical Center", "last_updated_on": "2026-03-17", "version": "3.0", "location_name": [ "Holy Family Medical Center" ], "hospital_address": [ "100 N. River Road, Des Plaines, Illinois 60016" ], "license_information": { "license_number": "992219992", "state": "IL" }, "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": "Yolande Wilson-Stubbs" }, "type_2_npi": [ "1205674611" ], "standard_charge_information": [ { "description": "ABORTION WITHOUT D&C", "code_information": [ { "code": "779", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 35212.0, "minimum": 4166.0, "maximum": 57043.926, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 42254.76, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 36972.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 33451.69, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 44015.38, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 49297.22, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 57043.93, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "case rate", "standard_charge_dollar": 35564.42, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "case rate", "standard_charge_dollar": 54579.07, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 8765.99 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link Inc HMO", "methodology": "case rate", "standard_charge_dollar": 9674.95 }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 7381.89 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 38733.53, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 45104.62 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 36972.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 36972.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 52818.45, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 36268.67, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "case rate", "standard_charge_dollar": 36268.67, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 36972.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 44015.38, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 8765.99 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 36268.67, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ABORTION WITH D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY", "code_information": [ { "code": "770", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 48067.0, "minimum": 3990.0, "maximum": 77869.188, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 57680.88, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 48067.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 50470.77, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 45664.03, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 48067.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 48067.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 60084.25, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 67294.36, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 77869.19, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 48067.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 48067.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "case rate", "standard_charge_dollar": 48548.07, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "case rate", "standard_charge_dollar": 74504.47, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 11454.44 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 48067.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link Inc HMO", "methodology": "case rate", "standard_charge_dollar": 11531.05 }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 9645.85 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 48067.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 52874.14, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 48067.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 53757.76 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 48067.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 50470.77, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 50470.77, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 72101.1, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 49509.42, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "case rate", "standard_charge_dollar": 49509.42, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 50470.77, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 48067.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 48067.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 60084.25, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 48067.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 48067.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 48067.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 11454.44 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 49509.42, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ACUTE ADJUSTMENT REACTION AND PSYCHOSOCIAL DYSFUNCTION", "code_information": [ { "code": "880", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 2077.6, "maximum": 51479.2, "payers_information": [ { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 9827.44 }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link Inc HMO", "methodology": "case rate", "standard_charge_dollar": 11042.3 }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 8275.74 }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 51479.2 }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 9827.44 } ] } ] }, { "description": "ACUTE AND SUBACUTE ENDOCARDITIS WITH MCC", "code_information": [ { "code": "288", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 52650.0, "minimum": 14060.0, "maximum": 145087.5, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 63180.6, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 52650.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 55283.03, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 50017.98, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 52650.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 52650.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 65813.13, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 73710.7, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 85293.81, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 52650.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 52650.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "case rate", "standard_charge_dollar": 53177.01, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "case rate", "standard_charge_dollar": 81608.28, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 62578.07 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 52650.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link Inc HMO", "methodology": "case rate", "standard_charge_dollar": 31121.3 }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 52697.32 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 52650.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 57915.55, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 52650.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 145087.5 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 52650.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 55283.03, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 55283.03, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 78975.75, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 54230.02, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "case rate", "standard_charge_dollar": 54230.02, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 55283.03, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 52650.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 52650.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 65813.13, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 52650.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 52650.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 52650.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 62578.07 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 54230.02, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ACUTE AND SUBACUTE ENDOCARDITIS WITH CC", "code_information": [ { "code": "289", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 36994.0, "minimum": 9690.0, "maximum": 91512.03, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 44393.76, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 36994.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 38844.54, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 35145.06, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 36994.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 36994.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 46243.5, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 51792.72, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 59931.58, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 36994.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 36994.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "case rate", "standard_charge_dollar": 37364.75, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "case rate", "standard_charge_dollar": 57341.94, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 34922.48 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 36994.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link Inc HMO", "methodology": "case rate", "standard_charge_dollar": 19629.35 }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 29408.41 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 36994.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 40694.28, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 36994.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 91512.03 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 36994.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 38844.54, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 38844.54, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 55492.2, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 38104.64, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "case rate", "standard_charge_dollar": 38104.64, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 38844.54, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 36994.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 36994.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 46243.5, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 36994.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 36994.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 36994.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 34922.48 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 38104.64, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ACUTE AND SUBACUTE ENDOCARDITIS WITHOUT CCMCC", "code_information": [ { "code": "290", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 35212.0, "minimum": 6650.0, "maximum": 57043.926, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 42254.76, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 36972.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 33451.69, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 44015.38, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 49297.22, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 57043.93, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "case rate", "standard_charge_dollar": 35564.42, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "case rate", "standard_charge_dollar": 54579.07, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 25794.95 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link Inc HMO", "methodology": "case rate", "standard_charge_dollar": 10691.55 }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 21722.06 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 38733.53, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 49844.01 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 36972.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 36972.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 52818.45, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 36268.67, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "case rate", "standard_charge_dollar": 36268.67, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 36972.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 44015.38, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 25794.95 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 36268.67, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ACUTE LEUKEMIA WITHOUT MAJOR O.R. PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "836", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 24697.0, "minimum": 4082.4, "maximum": 65381.05, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 29637.24, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 25932.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 23462.82, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 30872.13, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 34576.78, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 40010.27, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "case rate", "standard_charge_dollar": 24944.68, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "case rate", "standard_charge_dollar": 38281.44, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 28926.77 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link Inc HMO", "methodology": "case rate", "standard_charge_dollar": 14024.25 }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 24359.38 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 27167.47, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 65381.05 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 25932.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 25932.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 37046.55, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 25438.63, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "case rate", "standard_charge_dollar": 25438.63, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 25932.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 30872.13, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 28926.77 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 25438.63, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ACUTE MAJOR EYE INFECTIONS WITHOUT CCMCC", "code_information": [ { "code": "122", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 24697.0, "minimum": 4592.7, "maximum": 42129.1, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 29637.24, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 25932.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 23462.82, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 30872.13, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 34576.78, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 40010.27, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "case rate", "standard_charge_dollar": 24944.68, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "case rate", "standard_charge_dollar": 38281.44, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 8322.13 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link Inc HMO", "methodology": "case rate", "standard_charge_dollar": 9036.7 }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 7008.11 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 27167.47, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 42129.1 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 25932.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 25932.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 37046.55, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 25438.63, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "case rate", "standard_charge_dollar": 25438.63, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 25932.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 30872.13, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 8322.13 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 25438.63, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ACUTE MAJOR EYE INFECTIONS WITH CCMCC", "code_information": [ { "code": "121", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 24697.0, "minimum": 6974.1, "maximum": 62368.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 29637.24, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 25932.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 23462.82, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 30872.13, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 34576.78, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 40010.27, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "case rate", "standard_charge_dollar": 24944.68, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "case rate", "standard_charge_dollar": 38281.44, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 14339.49 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link Inc HMO", "methodology": "case rate", "standard_charge_dollar": 13377.95 }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 12075.36 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 27167.47, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 62368.0 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 25932.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 25932.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 37046.55, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 25438.63, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "case rate", "standard_charge_dollar": 25438.63, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 25932.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 30872.13, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 14339.49 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 25438.63, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITHOUT CCMCC", "code_information": [ { "code": "282", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 24697.0, "minimum": 3230.0, "maximum": 40010.274, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 29637.24, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 25932.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 23462.82, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 30872.13, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 34576.78, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 40010.27, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "case rate", "standard_charge_dollar": 24944.68, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "case rate", "standard_charge_dollar": 38281.44, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 33813.19 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link Inc HMO", "methodology": "case rate", "standard_charge_dollar": 8315.65 }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 28474.26 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 27167.47, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 38767.56 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 25932.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 25932.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 37046.55, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 25438.63, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "case rate", "standard_charge_dollar": 25438.63, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 25932.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 30872.13, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 33813.19 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 25438.63, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH MCC", "code_information": [ { "code": "280", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 42363.0, "minimum": 7790.0, "maximum": 86000.61, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 50835.84, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 42363.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 44481.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 40245.04, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 42363.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 42363.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 52954.0, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 59308.48, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 68628.38, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 42363.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 42363.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "case rate", "standard_charge_dollar": 42786.83, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "case rate", "standard_charge_dollar": 65662.96, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 53181.15 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 42363.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link Inc HMO", "methodology": "case rate", "standard_charge_dollar": 18447.15 }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 44784.13 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 42363.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 46599.52, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 42363.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 86000.61 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 42363.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 44481.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 44481.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 63544.8, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 43634.1, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "case rate", "standard_charge_dollar": 43634.1, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 44481.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 42363.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 42363.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 52954.0, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 42363.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 42363.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 42363.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 53181.15 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 43634.1, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ACUTE MYOCARDIAL INFARCTION, EXPIRED WITH CC", "code_information": [ { "code": "284", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 33000.0, "minimum": 3040.0, "maximum": 53461.296, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 39600.96, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 34650.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 31350.76, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 41251.0, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 46201.12, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 53461.3, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "case rate", "standard_charge_dollar": 33330.81, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "case rate", "standard_charge_dollar": 51151.24, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 30117.57 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link Inc HMO", "methodology": "case rate", "standard_charge_dollar": 7960.3 }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 25362.17 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 36300.88, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 37110.92 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 34650.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 34650.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 49501.2, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 33990.82, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "case rate", "standard_charge_dollar": 33990.82, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 34650.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 41251.0, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 30117.57 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 33990.82, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ACUTE LEUKEMIA WITHOUT MAJOR O.R. PROCEDURES WITH CC", "code_information": [ { "code": "835", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 24697.0, "minimum": 7484.4, "maximum": 115699.41, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 29637.24, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 25932.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 23462.82, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 30872.13, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 34576.78, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 40010.27, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "case rate", "standard_charge_dollar": 24944.68, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "case rate", "standard_charge_dollar": 38281.44, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 115699.41 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link Inc HMO", "methodology": "case rate", "standard_charge_dollar": 23986.7 }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 97431.08 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 27167.47, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 111826.0 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 25932.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 25932.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 37046.55, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 25438.63, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "case rate", "standard_charge_dollar": 25438.63, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 25932.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 30872.13, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 115699.41 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 25438.63, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ACUTE MYOCARDIAL INFARCTION, EXPIRED WITH MCC", "code_information": [ { "code": "283", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 48801.0, "minimum": 6080.0, "maximum": 106196.63, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 58561.32, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 48801.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 51241.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 46361.05, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 48801.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 48801.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 61001.38, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 68321.54, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 79057.78, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 48801.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 48801.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "case rate", "standard_charge_dollar": 49289.11, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "case rate", "standard_charge_dollar": 75641.71, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 41455.55 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 48801.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link Inc HMO", "methodology": "case rate", "standard_charge_dollar": 22779.2 }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 34909.94 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 48801.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 53681.21, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 48801.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 106196.63 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 48801.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 51241.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 51241.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 73201.65, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 50265.13, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "case rate", "standard_charge_dollar": 50265.13, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 51241.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 48801.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 48801.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 61001.38, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 48801.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 48801.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 48801.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 41455.55 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 50265.13, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ACUTE MYOCARDIAL INFARCTION, EXPIRED WITHOUT CCMCC", "code_information": [ { "code": "285", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 24697.0, "minimum": 2470.0, "maximum": 40010.274, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 29637.24, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 25932.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 23462.82, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 30872.13, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 34576.78, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 40010.27, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "case rate", "standard_charge_dollar": 24944.68, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "case rate", "standard_charge_dollar": 38281.44, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 14930.7 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link Inc HMO", "methodology": "case rate", "standard_charge_dollar": 6887.35 }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 12573.22 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 27167.47, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 32108.83 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 25932.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 25932.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 37046.55, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 25438.63, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "case rate", "standard_charge_dollar": 25438.63, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 25932.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 30872.13, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 14930.7 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 25438.63, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH CC", "code_information": [ { "code": "281", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 33000.0, "minimum": 4560.0, "maximum": 53461.296, "payers_information": [ { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 39349.63 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 33990.82, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 39600.96, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 34650.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 31350.76, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 41251.0, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 46201.12, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 53461.3, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "case rate", "standard_charge_dollar": 33330.81, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "case rate", "standard_charge_dollar": 51151.24, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 39349.63 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link Inc HMO", "methodology": "case rate", "standard_charge_dollar": 10569.65 }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 33136.53 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 36300.88, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 49275.71 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 34650.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 34650.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 49501.2, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 33990.82, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "case rate", "standard_charge_dollar": 33990.82, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 34650.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 41251.0, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ACUTE LEUKEMIA WITHOUT MAJOR O.R. PROCEDURES WITH MCC", "code_information": [ { "code": "834", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 35212.0, "minimum": 15989.4, "maximum": 294330.01, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 42254.76, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 36972.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 33451.69, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 44015.38, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 49297.22, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 57043.93, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "case rate", "standard_charge_dollar": 35564.42, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "case rate", "standard_charge_dollar": 54579.07, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 166912.52 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link Inc HMO", "methodology": "case rate", "standard_charge_dollar": 63133.85 }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 140557.91 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 38733.53, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 294330.01 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 36972.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 36972.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 52818.45, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 36268.67, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "case rate", "standard_charge_dollar": 36268.67, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 36972.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 44015.38, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 166912.52 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 36268.67, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ADRENAL AND PITUITARY PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "615", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 48801.0, "minimum": 2551.5, "maximum": 79057.782, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 58561.32, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 48801.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 51241.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 46361.05, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 48801.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 48801.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 61001.38, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 68321.54, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 79057.78, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 48801.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 48801.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "case rate", "standard_charge_dollar": 49289.11, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "case rate", "standard_charge_dollar": 75641.71, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 33151.29 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 48801.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link Inc HMO", "methodology": "case rate", "standard_charge_dollar": 16091.95 }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 27916.87 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 48801.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 53681.21, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 48801.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 75020.67 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 48801.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 51241.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 51241.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 73201.65, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 50265.13, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "case rate", "standard_charge_dollar": 50265.13, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 51241.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 48801.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 48801.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 61001.38, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 48801.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 48801.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 48801.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 33151.29 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 50265.13, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ADRENAL AND PITUITARY PROCEDURES WITH CCMCC", "code_information": [ { "code": "614", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 48801.0, "minimum": 4592.7, "maximum": 117508.97, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 58561.32, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 48801.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 51241.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 46361.05, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 48801.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 48801.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 61001.38, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 68321.54, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 79057.78, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 48801.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 48801.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "case rate", "standard_charge_dollar": 49289.11, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "case rate", "standard_charge_dollar": 75641.71, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 49396.16 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 48801.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link Inc HMO", "methodology": "case rate", "standard_charge_dollar": 25205.7 }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 41596.77 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 48801.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 53681.21, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 48801.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 117508.97 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 48801.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 51241.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 51241.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 73201.65, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 50265.13, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "case rate", "standard_charge_dollar": 50265.13, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 51241.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 48801.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 48801.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 61001.38, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 48801.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 48801.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 48801.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 49396.16 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 50265.13, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "AFTERCARE WITH CCMCC", "code_information": [ { "code": "949", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 35940.0, "minimum": 7484.4, "maximum": 66117.76, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 43128.96, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 35940.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 37737.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 34143.76, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 35940.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 35940.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 44926.0, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 50317.12, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 58224.1, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 35940.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 35940.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "case rate", "standard_charge_dollar": 36300.21, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "case rate", "standard_charge_dollar": 55708.24, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 66117.76 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 35940.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link Inc HMO", "methodology": "case rate", "standard_charge_dollar": 13681.55 }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 55678.11 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 35940.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 39534.88, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 35940.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 63783.39 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 35940.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 37737.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 37737.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 53911.2, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 37019.02, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "case rate", "standard_charge_dollar": 37019.02, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 37737.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 35940.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 35940.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 44926.0, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 35940.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 35940.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 35940.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 66117.76 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 37019.02, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH CC", "code_information": [ { "code": "560", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 32468.0, "minimum": 6293.7, "maximum": 60373.6, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 38962.44, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 32468.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 34092.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 30845.27, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 32468.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 32468.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 40585.88, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 45456.18, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 52599.29, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 32468.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 32468.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "case rate", "standard_charge_dollar": 32793.39, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "case rate", "standard_charge_dollar": 50326.49, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 18600.1 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 32468.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link Inc HMO", "methodology": "case rate", "standard_charge_dollar": 12950.15 }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 15663.24 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 32468.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 35715.57, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 32468.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 60373.6 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 32468.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 34092.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 34092.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 48703.05, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 33442.76, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "case rate", "standard_charge_dollar": 33442.76, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 34092.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 32468.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 32468.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 40585.88, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 32468.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 32468.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 32468.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 18600.1 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 33442.76, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ALCOHOL, DRUG ABUSE OR DEPENDENCE WITH REHABILITATION THERAPY", "code_information": [ { "code": "895", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 5639.2, "maximum": 75894.56, "payers_information": [ { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 17027.26 }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link Inc HMO", "methodology": "case rate", "standard_charge_dollar": 16279.4 }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 14338.74 }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 75894.56 }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 17027.26 } ] } ] }, { "description": "AFTERCARE WITHOUT CCMCC", "code_information": [ { "code": "950", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 24697.0, "minimum": 4932.9, "maximum": 40010.274, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 29637.24, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 25932.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 23462.82, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 30872.13, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 34576.78, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 40010.27, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "case rate", "standard_charge_dollar": 24944.68, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "case rate", "standard_charge_dollar": 38281.44, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 8100.82 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link Inc HMO", "methodology": "case rate", "standard_charge_dollar": 7218.55 }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 6821.74 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 27167.47, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 33652.88 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 25932.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 25932.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 37046.55, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 25438.63, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "case rate", "standard_charge_dollar": 25438.63, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 25932.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 30872.13, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 8100.82 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 25438.63, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "AICD GENERATOR PROCEDURES", "code_information": [ { "code": "245", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 65650.0, "minimum": 8170.0, "maximum": 244603.95, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 78780.36, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 65650.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 68932.82, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 62367.79, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 65650.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 65650.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 82062.88, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 91910.42, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 106353.49, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 65650.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 65650.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "case rate", "standard_charge_dollar": 66306.8, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "case rate", "standard_charge_dollar": 101757.97, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 43497.96 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 65650.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link Inc HMO", "methodology": "case rate", "standard_charge_dollar": 52467.6 }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 36629.86 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 65650.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 72215.33, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 65650.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 244603.95 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 65650.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 68932.82, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 68932.82, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 98475.45, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 67619.81, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "case rate", "standard_charge_dollar": 67619.81, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 68932.82, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 65650.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 65650.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 82062.88, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 65650.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 65650.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 65650.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 43497.96 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 67619.81, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC", "code_information": [ { "code": "559", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 41645.0, "minimum": 8675.1, "maximum": 99982.88, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 49974.0, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 41645.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 43727.25, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 39562.75, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 41645.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 41645.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 52056.25, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 58303.0, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 67464.9, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 41645.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 41645.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "case rate", "standard_charge_dollar": 42061.45, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "case rate", "standard_charge_dollar": 64549.75, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 59651.1 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 41645.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link Inc HMO", "methodology": "case rate", "standard_charge_dollar": 21446.35 }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 50232.5 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 41645.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 45809.5, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 41645.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 99982.88 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 41645.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 43727.25, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 43727.25, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 62467.5, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 42894.35, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "case rate", "standard_charge_dollar": 42894.35, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 43727.25, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 41645.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 41645.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 52056.25, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 41645.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 41645.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 41645.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 59651.1 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 42894.35, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ALCOHOL, DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITH MCC", "code_information": [ { "code": "896", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 3561.6, "maximum": 93560.05, "payers_information": [ { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 25019.06 }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link Inc HMO", "methodology": "case rate", "standard_charge_dollar": 20068.65 }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 21068.68 }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 93560.05 }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 25019.06 } ] } ] }, { "description": "AICD LEAD PROCEDURES", "code_information": [ { "code": "265", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 35212.0, "minimum": 7790.0, "maximum": 193982.56, "payers_information": [ { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 52818.45, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 36268.67, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "case rate", "standard_charge_dollar": 36268.67, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 36972.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 44015.38, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 83633.42 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 36268.67, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 42254.76, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 36972.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 33451.69, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 44015.38, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 49297.22, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 57043.93, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "case rate", "standard_charge_dollar": 35564.42, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "case rate", "standard_charge_dollar": 54579.07, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 83633.42 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link Inc HMO", "methodology": "case rate", "standard_charge_dollar": 41609.3 }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 70428.14 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 38733.53, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 193982.56 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 36972.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 36972.92, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT CCMCC", "code_information": [ { "code": "561", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 31729.0, "minimum": 4762.8, "maximum": 51402.276, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 38075.76, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 31729.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 33316.29, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 30143.31, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 31729.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 31729.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 39662.25, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 44421.72, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 51402.28, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 31729.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 31729.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "case rate", "standard_charge_dollar": 32047.1, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "case rate", "standard_charge_dollar": 49181.19, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 10929.03 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 31729.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link Inc HMO", "methodology": "case rate", "standard_charge_dollar": 9244.85 }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 9203.39 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 31729.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 34902.78, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 31729.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 43099.49 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 31729.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 33316.29, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 33316.29, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 47594.7, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 32681.69, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "case rate", "standard_charge_dollar": 32681.69, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 33316.29, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 31729.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 31729.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 39662.25, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 31729.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 31729.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 31729.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 10929.03 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 32681.69, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ALCOHOL, DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITHOUT MCC", "code_information": [ { "code": "897", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 2448.6, "maximum": 47329.56, "payers_information": [ { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 9117.34 }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link Inc HMO", "methodology": "case rate", "standard_charge_dollar": 10152.2 }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 7677.76 }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 47329.56 }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 9117.34 } ] } ] }, { "description": "ALCOHOL, DRUG ABUSE OR DEPENDENCE, LEFT AMA", "code_information": [ { "code": "894", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 1558.2, "maximum": 33073.86, "payers_information": [ { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 7775.65 }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link Inc HMO", "methodology": "case rate", "standard_charge_dollar": 7094.35 }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 6547.91 }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 33073.86 }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 7775.65 } ] } ] }, { "description": "ALLERGIC REACTIONS WITH MCC", "code_information": [ { "code": "915", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 33000.0, "minimum": 6293.7, "maximum": 90155.62, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 39600.96, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 34650.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 31350.76, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 41251.0, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 46201.12, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 53461.3, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "case rate", "standard_charge_dollar": 33330.81, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "case rate", "standard_charge_dollar": 51151.24, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 25229.77 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link Inc HMO", "methodology": "case rate", "standard_charge_dollar": 19338.4 }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 21246.12 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 36300.88, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 90155.62 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 34650.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 34650.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 49501.2, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 33990.82, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "case rate", "standard_charge_dollar": 33990.82, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 34650.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 41251.0, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 25229.77 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 33990.82, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ALLERGIC REACTIONS WITHOUT MCC", "code_information": [ { "code": "916", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 33000.0, "minimum": 3061.8, "maximum": 53461.296, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 39600.96, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 34650.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 31350.76, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 41251.0, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 46201.12, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 53461.3, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "case rate", "standard_charge_dollar": 33330.81, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "case rate", "standard_charge_dollar": 51151.24, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 7888.04 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link Inc HMO", "methodology": "case rate", "standard_charge_dollar": 7662.45 }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 6642.56 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 36300.88, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 35722.34 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 34650.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 34650.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 49501.2, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 33990.82, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "case rate", "standard_charge_dollar": 33990.82, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 34650.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 41251.0, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 7888.04 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 33990.82, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ALLOGENEIC BONE MARROW TRANSPLANT", "code_information": [ { "code": "014", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 24697.0, "minimum": 23462.815, "maximum": 644315.67, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 29637.24, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 25932.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 23462.82, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 30872.13, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 34576.78, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 40010.27, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "case rate", "standard_charge_dollar": 24944.68, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "case rate", "standard_charge_dollar": 38281.44, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link Inc HMO", "methodology": "case rate", "standard_charge_dollar": 138205.85 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 27167.47, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 644315.67 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 25932.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 25932.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 37046.55, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 25438.63, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "case rate", "standard_charge_dollar": 25438.63, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 25932.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 30872.13, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 25438.63, "additional_payer_notes": "103.00% 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", "discounted_cash": 65221.0, "minimum": 13870.0, "maximum": 152823.86, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 78265.8, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 68482.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 61960.43, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 81526.88, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 91310.1, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 105658.83, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "case rate", "standard_charge_dollar": 65873.72, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "case rate", "standard_charge_dollar": 101093.33, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 62744.67 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link Inc HMO", "methodology": "case rate", "standard_charge_dollar": 32780.75 }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 52837.62 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 71743.65, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 152823.86 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 68482.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 68482.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 97832.25, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 67178.15, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "case rate", "standard_charge_dollar": 67178.15, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 68482.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 81526.88, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 62744.67 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 67178.15, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ANAL AND STOMAL PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "349", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 33000.0, "minimum": 2891.7, "maximum": 53461.296, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 39600.96, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 34650.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 31350.76, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 41251.0, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 46201.12, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 53461.3, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "case rate", "standard_charge_dollar": 33330.81, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "case rate", "standard_charge_dollar": 51151.24, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 12854.77 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link Inc HMO", "methodology": "case rate", "standard_charge_dollar": 10011.9 }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 10825.07 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 36300.88, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 46675.48 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 34650.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 34650.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 49501.2, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 33990.82, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "case rate", "standard_charge_dollar": 33990.82, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 34650.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 41251.0, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 12854.77 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 33990.82, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITH CC", "code_information": [ { "code": "475", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 35212.0, "minimum": 9695.7, "maximum": 122007.1, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 42254.76, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 36972.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 33451.69, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 44015.38, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 49297.22, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 57043.93, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "case rate", "standard_charge_dollar": 35564.42, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "case rate", "standard_charge_dollar": 54579.07, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 41411.89 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link Inc HMO", "methodology": "case rate", "standard_charge_dollar": 26170.55 }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 34873.17 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 38733.53, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 122007.1 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 36972.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 36972.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 52818.45, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 36268.67, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "case rate", "standard_charge_dollar": 36268.67, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 36972.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 44015.38, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 41411.89 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 36268.67, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITHOUT CCMCC", "code_information": [ { "code": "476", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 35212.0, "minimum": 4252.5, "maximum": 63274.06, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 42254.76, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 36972.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 33451.69, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 44015.38, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 49297.22, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 57043.93, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "case rate", "standard_charge_dollar": 35564.42, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "case rate", "standard_charge_dollar": 54579.07, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 17825.26 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link Inc HMO", "methodology": "case rate", "standard_charge_dollar": 13572.3 }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 15010.74 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 38733.53, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 63274.06 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 36972.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 36972.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 52818.45, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 36268.67, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "case rate", "standard_charge_dollar": 36268.67, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 36972.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 44015.38, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 17825.26 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 36268.67, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "Amputation follow-up surgery", "code_information": [ { "code": "27884", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 19125.0, "discounted_cash": 3489.0, "minimum": 639.41, "maximum": 15300.0, "payers_information": [ { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4012.52, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2712.76 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 3838.07, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 3250.0 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3663.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2848.4 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3663.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5233.73, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2848.4 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3593.82, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 3593.82, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3663.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Commercial", "methodology": "fee schedule", "standard_charge_dollar": 639.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 639.41 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 2711.4 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2712.76 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4361.44, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3593.82, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 4186.98, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1163.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3663.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2712.76 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3314.69, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2712.76 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 4710.35, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 4884.81, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5652.42, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 5408.18, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2712.76 } ] } ] }, { "description": "AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITH MCC", "code_information": [ { "code": "474", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 65221.0, "minimum": 17350.2, "maximum": 230155.25, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 78265.8, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 68482.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 61960.43, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 81526.88, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 91310.1, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 105658.83, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "case rate", "standard_charge_dollar": 65873.72, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "case rate", "standard_charge_dollar": 101093.33, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 107695.19 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link Inc HMO", "methodology": "case rate", "standard_charge_dollar": 49368.35 }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 90690.69 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 71743.65, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 230155.25 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 68482.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 68482.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 97832.25, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 67178.15, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "case rate", "standard_charge_dollar": 67178.15, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 68482.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 81526.88, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 107695.19 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 67178.15, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "AMPUTATION OF LOWER LIMB FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH MCC", "code_information": [ { "code": "616", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 48801.0, "minimum": 17010.0, "maximum": 186969.98, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 58561.32, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 48801.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 51241.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 46361.05, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 48801.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 48801.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 61001.38, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 68321.54, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 79057.78, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 48801.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 48801.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "case rate", "standard_charge_dollar": 49289.11, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "case rate", "standard_charge_dollar": 75641.71, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 86733.79 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 48801.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link Inc HMO", "methodology": "case rate", "standard_charge_dollar": 40105.1 }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 73038.98 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 48801.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 53681.21, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 48801.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 186969.98 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 48801.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 51241.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 51241.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 73201.65, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 50265.13, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "case rate", "standard_charge_dollar": 50265.13, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 51241.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 48801.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 48801.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 61001.38, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 48801.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 48801.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 48801.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 86733.79 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 50265.13, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITH MCC", "code_information": [ { "code": "239", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 65221.0, "minimum": 21470.0, "maximum": 263867.1, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 78265.8, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 68482.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 61960.43, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 81526.88, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 91310.1, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 105658.83, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "case rate", "standard_charge_dollar": 65873.72, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "case rate", "standard_charge_dollar": 101093.33, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 113070.76 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link Inc HMO", "methodology": "case rate", "standard_charge_dollar": 56599.55 }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 95217.48 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 71743.65, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 263867.1 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 68482.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 68482.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 97832.25, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 67178.15, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "case rate", "standard_charge_dollar": 67178.15, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 68482.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 81526.88, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 113070.76 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 67178.15, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "AMPUTATION OF LOWER LIMB FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH CC", "code_information": [ { "code": "617", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 48801.0, "minimum": 9695.7, "maximum": 100272.39, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 58561.32, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 48801.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 51241.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 46361.05, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 48801.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 48801.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 61001.38, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 68321.54, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 79057.78, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 48801.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 48801.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "case rate", "standard_charge_dollar": 49289.11, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "case rate", "standard_charge_dollar": 75641.71, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 39132.25 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 48801.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link Inc HMO", "methodology": "case rate", "standard_charge_dollar": 21508.45 }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 32953.47 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 48801.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 53681.21, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 48801.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 100272.39 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 48801.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 51241.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 51241.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 73201.65, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 50265.13, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "case rate", "standard_charge_dollar": 50265.13, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 51241.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 48801.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 48801.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 61001.38, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 48801.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 48801.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 48801.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 39132.25 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 50265.13, "additional_payer_notes": "103.00% 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", "discounted_cash": 65221.0, "minimum": 8360.0, "maximum": 105658.83, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 78265.8, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 68482.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 61960.43, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 81526.88, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 91310.1, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 105658.83, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "case rate", "standard_charge_dollar": 65873.72, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "case rate", "standard_charge_dollar": 101093.33, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 43586.88 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link Inc HMO", "methodology": "case rate", "standard_charge_dollar": 15920.6 }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 36704.74 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 71743.65, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 74221.84 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 68482.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 68482.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 97832.25, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 67178.15, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "case rate", "standard_charge_dollar": 67178.15, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 68482.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 81526.88, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 43586.88 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 67178.15, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ANAL AND STOMAL PROCEDURES WITH CC", "code_information": [ { "code": "348", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 37480.0, "minimum": 5273.1, "maximum": 70168.69, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 44976.6, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 37480.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 39354.53, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 35606.48, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 37480.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 37480.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 46850.63, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 52472.7, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 60718.41, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 37480.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 37480.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "case rate", "standard_charge_dollar": 37855.31, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "case rate", "standard_charge_dollar": 58094.78, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 20943.86 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 37480.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link Inc HMO", "methodology": "case rate", "standard_charge_dollar": 15051.2 }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 17636.94 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 37480.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 41228.55, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 37480.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 70168.69 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 37480.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 39354.53, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 39354.53, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 56220.75, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 38604.92, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "case rate", "standard_charge_dollar": 38604.92, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 39354.53, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 37480.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 37480.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 46850.63, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 37480.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 37480.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 37480.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 20943.86 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 38604.92, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ANAL AND STOMAL PROCEDURES WITH MCC", "code_information": [ { "code": "347", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 46166.0, "minimum": 9525.6, "maximum": 123074.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 55399.2, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 46166.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 48474.3, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 43857.7, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 46166.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 46166.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 57707.5, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 64632.4, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 74788.92, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 46166.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 46166.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "case rate", "standard_charge_dollar": 46627.66, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "case rate", "standard_charge_dollar": 71557.3, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 54132.48 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 46166.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link Inc HMO", "methodology": "case rate", "standard_charge_dollar": 26399.4 }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 45585.25 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 46166.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 50782.6, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 46166.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 123074.0 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 46166.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 48474.3, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 48474.3, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 69249.0, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 47550.98, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "case rate", "standard_charge_dollar": 47550.98, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 48474.3, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 46166.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 46166.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 57707.5, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 46166.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 46166.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 46166.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 54132.48 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 47550.98, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "AMPUTATION OF LOWER LIMB FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITHOUT CCMCC", "code_information": [ { "code": "618", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 35212.0, "minimum": 7144.2, "maximum": 76039.32, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 42254.76, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 36972.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 33451.69, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 44015.38, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 49297.22, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 57043.93, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "case rate", "standard_charge_dollar": 35564.42, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "case rate", "standard_charge_dollar": 54579.07, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 34299.66 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link Inc HMO", "methodology": "case rate", "standard_charge_dollar": 16310.45 }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 28883.92 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 38733.53, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 76039.32 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 36972.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 36972.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 52818.45, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 36268.67, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "case rate", "standard_charge_dollar": 36268.67, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 36972.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 44015.38, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 34299.66 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 36268.67, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ATHEROSCLEROSIS WITHOUT MCC", "code_information": [ { "code": "303", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 24697.0, "minimum": 3061.8, "maximum": 40010.274, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 23462.82, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 30872.13, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 34576.78, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 40010.27, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "case rate", "standard_charge_dollar": 24944.68, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "case rate", "standard_charge_dollar": 38281.44, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 18420.0 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link Inc HMO", "methodology": "case rate", "standard_charge_dollar": 7741.8 }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 15511.58 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 27167.47, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 36092.27 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 25932.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 25932.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 37046.55, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 25438.63, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "case rate", "standard_charge_dollar": 25438.63, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 25932.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 30872.13, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 18420.0 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 25438.63, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 29637.24, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 25932.59, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON WITHOUT MCC", "code_information": [ { "code": "269", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 65221.0, "minimum": 2551.5, "maximum": 226418.42, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 78265.8, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 68482.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 61960.43, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 81526.88, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 91310.1, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 105658.83, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "case rate", "standard_charge_dollar": 65873.72, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "case rate", "standard_charge_dollar": 101093.33, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link Inc HMO", "methodology": "case rate", "standard_charge_dollar": 48566.8 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 71743.65, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 226418.42 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 68482.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 68482.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 97832.25, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 67178.15, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "case rate", "standard_charge_dollar": 67178.15, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 68482.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 81526.88, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 67178.15, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "Amputation toe & metatarsal", "code_information": [ { "code": "28810", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10451.0, "discounted_cash": 3489.0, "minimum": 440.58, "maximum": 8360.8, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 4186.98, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1020.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3663.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4725.55 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3314.69, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4725.55 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 4710.35, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 4884.81, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5652.42, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 5408.18, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4725.55 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4012.52, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4725.55 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 3838.07, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 1500.0 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3663.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4961.83 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3663.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5233.73, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4961.83 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3593.82, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 3593.82, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3663.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Commercial", "methodology": "fee schedule", "standard_charge_dollar": 440.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 440.58 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 4723.18 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4725.55 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4361.44, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3593.82, "additional_payer_notes": "103.00% of Medicare Rates" } ] }, { "setting": "outpatient", "gross_charge": 10451.0, "discounted_cash": 3489.0, "minimum": 440.58, "maximum": 8360.8, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 4186.98, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1020.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3663.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4725.55 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3314.69, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4725.55 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 4710.35, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 4884.81, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5652.42, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 5408.18, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4725.55 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4012.52, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4725.55 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 3838.07, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 1500.0 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3663.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4961.83 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3663.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5233.73, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4961.83 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3593.82, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 3593.82, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3663.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Commercial", "methodology": "fee schedule", "standard_charge_dollar": 440.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 440.58 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 4723.18 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4725.55 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4361.44, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3489.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3593.82, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ANGINA PECTORIS", "code_information": [ { "code": "311", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 35212.0, "minimum": 3402.0, "maximum": 57043.926, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 42254.76, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 36972.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 33451.69, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 44015.38, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 49297.22, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 57043.93, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "case rate", "standard_charge_dollar": 35564.42, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "case rate", "standard_charge_dollar": 54579.07, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 11502.94 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link Inc HMO", "methodology": "case rate", "standard_charge_dollar": 8071.85 }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 9686.69 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 38733.53, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 37630.96 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 36972.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 36972.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 52818.45, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 36268.67, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "case rate", "standard_charge_dollar": 36268.67, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 36972.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 44015.38, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 11502.94 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 36268.67, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITHOUT CCMCC", "code_information": [ { "code": "520", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 37480.0, "minimum": 3402.0, "maximum": 80092.46, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 44976.6, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 37480.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 39354.53, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 35606.48, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 37480.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 37480.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 46850.63, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 52472.7, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 60718.41, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 37480.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 37480.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "case rate", "standard_charge_dollar": 37855.31, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "case rate", "standard_charge_dollar": 58094.78, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 37480.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link Inc HMO", "methodology": "case rate", "standard_charge_dollar": 17179.85 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 37480.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 41228.55, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 37480.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 80092.46 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 37480.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 39354.53, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 39354.53, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 56220.75, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 38604.92, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "case rate", "standard_charge_dollar": 38604.92, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 39354.53, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 37480.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 37480.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 46850.63, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 37480.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 37480.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 37480.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 38604.92, "additional_payer_notes": "103.00% 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", "discounted_cash": 65221.0, "minimum": 10206.0, "maximum": 368744.85, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 78265.8, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 68482.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 61960.43, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 81526.88, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 91310.1, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 105658.83, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "case rate", "standard_charge_dollar": 65873.72, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "case rate", "standard_charge_dollar": 101093.33, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link Inc HMO", "methodology": "case rate", "standard_charge_dollar": 79095.85 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 71743.65, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 368744.85 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 68482.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 68482.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 97832.25, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 67178.15, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "case rate", "standard_charge_dollar": 67178.15, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 68482.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 81526.88, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 67178.15, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "APPENDIX PROCEDURES WITH CC", "code_information": [ { "code": "398", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 37480.0, "minimum": 5103.0, "maximum": 81148.64, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 44976.6, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 37480.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 39354.53, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 35606.48, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 37480.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 37480.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 46850.63, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 52472.7, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 60718.41, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 37480.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 37480.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "case rate", "standard_charge_dollar": 37855.31, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "case rate", "standard_charge_dollar": 58094.78, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 37480.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link Inc HMO", "methodology": "case rate", "standard_charge_dollar": 17406.4 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 37480.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 41228.55, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 37480.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 81148.64 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 37480.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 39354.53, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 39354.53, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 56220.75, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 38604.92, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "case rate", "standard_charge_dollar": 38604.92, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 39354.53, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 37480.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 37480.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 46850.63, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 37480.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 37480.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 37480.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 38604.92, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "BILATERAL OR MULTIPLE MAJOR JOINT PROCEDURES OF LOWER EXTREMITY WITH MCC", "code_information": [ { "code": "461", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 45318.0, "minimum": 12077.1, "maximum": 296104.6, "payers_information": [ { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 45318.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 296104.6 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 45318.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 47584.64, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 47584.64, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 67978.05, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 46678.26, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "case rate", "standard_charge_dollar": 46678.26, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 47584.64, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 45318.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 45318.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 56648.38, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 45318.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 45318.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 45318.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 92962.9 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 46678.26, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 54382.44, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 45318.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 47584.64, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 43052.77, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 45318.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 45318.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 56648.38, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 63446.18, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 73416.29, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 45318.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 45318.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "case rate", "standard_charge_dollar": 45771.89, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "case rate", "standard_charge_dollar": 70243.99, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 92962.9 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 45318.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link Inc HMO", "methodology": "case rate", "standard_charge_dollar": 63514.5 }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 78284.54 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 45318.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 49850.57, "additional_payer_notes": "110.00% of Medicare Rates" } ] } ] }, { "description": "BILIARY TRACT PROCEDURES EXCEPT ONLY CHOLECYSTECTOMY WITH OR WITHOUT C.D.E. WITH MCC", "code_information": [ { "code": "408", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 37155.0, "minimum": 12757.5, "maximum": 191162.51, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 44586.0, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 37155.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 39012.75, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 35297.25, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 37155.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 37155.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 46443.75, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 52017.0, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 60191.1, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 37155.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 37155.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "case rate", "standard_charge_dollar": 37526.55, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "case rate", "standard_charge_dollar": 57590.25, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 68383.76 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 37155.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link Inc HMO", "methodology": "case rate", "standard_charge_dollar": 41004.4 }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 57586.33 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 37155.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 40870.5, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 37155.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 191162.51 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 37155.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 39012.75, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 39012.75, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 55732.5, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 38269.65, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "case rate", "standard_charge_dollar": 38269.65, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 39012.75, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 37155.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 37155.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 46443.75, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 37155.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 37155.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 37155.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 68383.76 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 38269.65, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "APPENDIX PROCEDURES WITH MCC", "code_information": [ { "code": "397", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 46166.0, "minimum": 8675.1, "maximum": 128397.77, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 55399.2, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 46166.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 48474.3, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 43857.7, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 46166.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 46166.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 57707.5, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 64632.4, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 74788.92, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 46166.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 46166.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "case rate", "standard_charge_dollar": 46627.66, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "case rate", "standard_charge_dollar": 71557.3, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 46166.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link Inc HMO", "methodology": "case rate", "standard_charge_dollar": 27541.35 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 46166.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 50782.6, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 46166.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 128397.77 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 46166.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 48474.3, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 48474.3, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 69249.0, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 47550.98, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "case rate", "standard_charge_dollar": 47550.98, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 48474.3, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 46166.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 46166.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 57707.5, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 46166.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 46166.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 46166.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 47550.98, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ATHEROSCLEROSIS WITH MCC", "code_information": [ { "code": "302", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 33000.0, "minimum": 4762.8, "maximum": 64153.32, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 39600.96, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 34650.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 31350.76, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 41251.0, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 46201.12, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 53461.3, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "case rate", "standard_charge_dollar": 33330.81, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "case rate", "standard_charge_dollar": 51151.24, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 30981.94 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link Inc HMO", "methodology": "case rate", "standard_charge_dollar": 13760.9 }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 26090.06 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 36300.88, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 64153.32 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 34650.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 34650.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 49501.2, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 33990.82, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "case rate", "standard_charge_dollar": 33990.82, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 34650.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 41251.0, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 30981.94 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 33990.82, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ARTHROSCOPY", "code_information": [ { "code": "509", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 33000.0, "minimum": 6804.0, "maximum": 53461.296, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 39600.96, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 34650.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 31350.76, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 41251.0, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 46201.12, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 53461.3, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "case rate", "standard_charge_dollar": 33330.81, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "case rate", "standard_charge_dollar": 51151.24, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 20965.72 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 17655.34 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 36300.88, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 34650.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 34650.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 49501.2, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 33990.82, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "case rate", "standard_charge_dollar": 33990.82, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 34650.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 41251.0, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 20965.72 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 33990.82, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "BONE DISEASES AND ARTHROPATHIES WITH MCC", "code_information": [ { "code": "553", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 35212.0, "minimum": 6974.1, "maximum": 69498.53, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 42254.76, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 36972.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 33451.69, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 44015.38, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 49297.22, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 57043.93, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "case rate", "standard_charge_dollar": 35564.42, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "case rate", "standard_charge_dollar": 54579.07, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 21752.69 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link Inc HMO", "methodology": "case rate", "standard_charge_dollar": 14907.45 }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 18318.06 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 38733.53, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 69498.53 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 36972.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 36972.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 52818.45, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 36268.67, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "case rate", "standard_charge_dollar": 36268.67, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 36972.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 44015.38, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 21752.69 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 36268.67, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "APPENDIX PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "399", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 33000.0, "minimum": 3231.9, "maximum": 61370.8, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 39600.96, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 34650.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 31350.76, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 41251.0, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 46201.12, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 53461.3, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "case rate", "standard_charge_dollar": 33330.81, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "case rate", "standard_charge_dollar": 51151.24, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link Inc HMO", "methodology": "case rate", "standard_charge_dollar": 13164.05 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 36300.88, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 61370.8 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 34650.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 34650.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 49501.2, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 33990.82, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "case rate", "standard_charge_dollar": 33990.82, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 34650.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 41251.0, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 33990.82, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "Aqueous shunt eye w/graft", "code_information": [ { "code": "66180", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 9090.0, "discounted_cash": 5674.0, "minimum": 1026.87, "maximum": 9090.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 6809.35, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1637.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5674.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 5958.18, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2883.64 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 5390.74, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2883.64 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 5674.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 5674.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 7660.52, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 7944.24, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9090.0, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5674.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5674.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "fee schedule", "standard_charge_dollar": 5674.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 8795.41, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2883.64 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5674.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6525.63, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5674.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2883.64 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5674.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 6241.91, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5674.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5674.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 5958.18, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3027.82 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5958.18, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8511.69, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3027.82 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5844.69, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 5844.69, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5958.18, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1026.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5674.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1026.87 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5674.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 5674.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 2882.19 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2883.64 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5674.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5674.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7093.08, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5674.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 5674.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5674.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5844.69, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "AUTOLOGOUS BONE MARROW TRANSPLANT WITH CCMCC", "code_information": [ { "code": "016", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 35212.0, "minimum": 27726.3, "maximum": 317909.01, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 42254.76, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 36972.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 33451.69, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 44015.38, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 49297.22, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 57043.93, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "case rate", "standard_charge_dollar": 35564.42, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "case rate", "standard_charge_dollar": 54579.07, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link Inc HMO", "methodology": "case rate", "standard_charge_dollar": 68191.55 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 38733.53, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 317909.01 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 36972.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 36972.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 52818.45, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 36268.67, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "case rate", "standard_charge_dollar": 36268.67, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 36972.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 44015.38, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 36268.67, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "AUTOLOGOUS BONE MARROW TRANSPLANT WITHOUT CCMCC", "code_information": [ { "code": "017", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 24697.0, "minimum": 23462.815, "maximum": 291241.9, "payers_information": [ { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "case rate", "standard_charge_dollar": 24944.68, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "case rate", "standard_charge_dollar": 38281.44, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link Inc HMO", "methodology": "case rate", "standard_charge_dollar": 62471.45 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 27167.47, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 291241.9 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 25932.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 25932.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 37046.55, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 25438.63, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "case rate", "standard_charge_dollar": 25438.63, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 25932.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 30872.13, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 25438.63, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 29637.24, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 25932.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 23462.82, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 30872.13, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 34576.78, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 40010.27, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITH MCC OR DISC DEVICE OR NEUROSTIMULATOR", "code_information": [ { "code": "518", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 65221.0, "minimum": 9185.4, "maximum": 200367.86, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 78265.8, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 68482.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 61960.43, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 81526.88, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 91310.1, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 105658.83, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "case rate", "standard_charge_dollar": 65873.72, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "case rate", "standard_charge_dollar": 101093.33, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link Inc HMO", "methodology": "case rate", "standard_charge_dollar": 42978.95 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 71743.65, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 200367.86 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 68482.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 68482.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 97832.25, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 67178.15, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "case rate", "standard_charge_dollar": 67178.15, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 68482.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 81526.88, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 67178.15, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "BRONCHITIS AND ASTHMA WITHOUT CCMCC", "code_information": [ { "code": "203", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 24697.0, "minimum": 3572.1, "maximum": 40010.274, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 29637.24, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 25932.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 23462.82, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 30872.13, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 34576.78, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 40010.27, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "case rate", "standard_charge_dollar": 24944.68, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "case rate", "standard_charge_dollar": 38281.44, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 9417.4 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link Inc HMO", "methodology": "case rate", "standard_charge_dollar": 7705.0 }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 7930.44 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 27167.47, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 35920.71 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 25932.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 25932.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 37046.55, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 25438.63, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "case rate", "standard_charge_dollar": 25438.63, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 25932.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 30872.13, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 9417.4 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 25438.63, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITH CC", "code_information": [ { "code": "519", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 65221.0, "minimum": 5443.2, "maximum": 107236.72, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 78265.8, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 68482.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 61960.43, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 81526.88, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 91310.1, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 105658.83, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "case rate", "standard_charge_dollar": 65873.72, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "case rate", "standard_charge_dollar": 101093.33, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link Inc HMO", "methodology": "case rate", "standard_charge_dollar": 23002.3 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 71743.65, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 107236.72 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 68482.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 68482.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 97832.25, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 67178.15, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "case rate", "standard_charge_dollar": 67178.15, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 68482.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 81526.88, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 67178.15, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITH CC", "code_information": [ { "code": "095", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 35212.0, "minimum": 9355.5, "maximum": 138278.65, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 42254.76, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 36972.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 33451.69, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 44015.38, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 49297.22, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 57043.93, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "case rate", "standard_charge_dollar": 35564.42, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "case rate", "standard_charge_dollar": 54579.07, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 54166.77 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link Inc HMO", "methodology": "case rate", "standard_charge_dollar": 29660.8 }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 45614.12 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 38733.53, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 138278.65 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 36972.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 36972.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 52818.45, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 36268.67, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "case rate", "standard_charge_dollar": 36268.67, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 36972.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 44015.38, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 54166.77 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 36268.67, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITH MCC", "code_information": [ { "code": "094", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 55347.0, "minimum": 13437.9, "maximum": 188685.59, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 66417.12, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 55347.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 58114.98, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 52580.22, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 55347.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 55347.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 69184.5, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 77486.64, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 89663.11, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 55347.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 55347.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "case rate", "standard_charge_dollar": 55901.08, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "case rate", "standard_charge_dollar": 85788.78, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 77016.41 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 55347.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link Inc HMO", "methodology": "case rate", "standard_charge_dollar": 40473.1 }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 64855.92 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 55347.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 60882.36, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 55347.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 188685.59 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 55347.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 58114.98, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 58114.98, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 83021.4, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 57008.03, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "case rate", "standard_charge_dollar": 57008.03, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 58114.98, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 55347.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 55347.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 69184.5, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 55347.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 55347.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 55347.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 77016.41 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 57008.03, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITHOUT CCMCC", "code_information": [ { "code": "096", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 35212.0, "minimum": 9355.5, "maximum": 138278.65, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 42254.76, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 36972.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 33451.69, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 44015.38, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 49297.22, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 57043.93, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "case rate", "standard_charge_dollar": 35564.42, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "case rate", "standard_charge_dollar": 54579.07, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 36575.98 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link Inc HMO", "methodology": "case rate", "standard_charge_dollar": 29660.8 }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 30800.82 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 38733.53, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 138278.65 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 36972.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 36972.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 52818.45, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 36268.67, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "case rate", "standard_charge_dollar": 36268.67, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 36972.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 44015.38, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 36575.98 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 36268.67, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "BENIGN PROSTATIC HYPERTROPHY WITH MCC", "code_information": [ { "code": "725", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 24697.0, "minimum": 6633.9, "maximum": 62737.93, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 29637.24, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 25932.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 23462.82, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 30872.13, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 34576.78, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 40010.27, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "case rate", "standard_charge_dollar": 24944.68, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "case rate", "standard_charge_dollar": 38281.44, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link Inc HMO", "methodology": "case rate", "standard_charge_dollar": 13457.3 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 27167.47, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 62737.93 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 25932.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 25932.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 37046.55, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 25438.63, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "case rate", "standard_charge_dollar": 25438.63, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 25932.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 30872.13, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 25438.63, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "BEHAVIORAL AND DEVELOPMENTAL DISORDERS", "code_information": [ { "code": "886", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 3413.2, "maximum": 111263.06, "payers_information": [ { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 9315.33 }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link Inc HMO", "methodology": "case rate", "standard_charge_dollar": 23865.95 }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 7844.49 }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 111263.06 }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 9315.33 } ] } ] }, { "description": "BENIGN PROSTATIC HYPERTROPHY WITHOUT MCC", "code_information": [ { "code": "726", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 24697.0, "minimum": 4082.4, "maximum": 40010.274, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 29637.24, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 25932.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 23462.82, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 30872.13, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 34576.78, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 40010.27, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "case rate", "standard_charge_dollar": 24944.68, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "case rate", "standard_charge_dollar": 38281.44, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 14383.19 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link Inc HMO", "methodology": "case rate", "standard_charge_dollar": 8303.0 }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 12112.16 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 27167.47, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 38708.59 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 25932.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 25932.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 37046.55, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 25438.63, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "case rate", "standard_charge_dollar": 25438.63, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 25932.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 30872.13, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 14383.19 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 25438.63, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "BILIARY TRACT PROCEDURES EXCEPT ONLY CHOLECYSTECTOMY WITH OR WITHOUT C.D.E. WITHOUT CCMCC", "code_information": [ { "code": "410", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 33000.0, "minimum": 5613.3, "maximum": 85121.36, "payers_information": [ { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "case rate", "standard_charge_dollar": 51151.24, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 32174.87 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link Inc HMO", "methodology": "case rate", "standard_charge_dollar": 18258.55 }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 27094.62 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 36300.88, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 85121.36 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 34650.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 34650.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 49501.2, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 33990.82, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "case rate", "standard_charge_dollar": 33990.82, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 34650.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 41251.0, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 32174.87 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 33990.82, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 39600.96, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 34650.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 31350.76, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 41251.0, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 46201.12, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 53461.3, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "case rate", "standard_charge_dollar": 33330.81, "additional_payer_notes": "101.00% of Medicare Rates" } ] } ] }, { "description": "BILATERAL OR MULTIPLE MAJOR JOINT PROCEDURES OF LOWER EXTREMITY WITHOUT MCC", "code_information": [ { "code": "462", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 36323.0, "minimum": 3742.2, "maximum": 142610.58, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 43587.72, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 36323.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 38139.26, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 34506.95, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 36323.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 36323.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 45403.88, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 50852.34, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 58843.42, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 36323.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 36323.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "case rate", "standard_charge_dollar": 36686.33, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "case rate", "standard_charge_dollar": 56300.81, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 37479.62 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 36323.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link Inc HMO", "methodology": "case rate", "standard_charge_dollar": 30590.0 }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 31561.78 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 36323.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 39955.41, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 36323.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 142610.58 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 36323.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 38139.26, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 38139.26, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 54484.65, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 37412.79, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "case rate", "standard_charge_dollar": 37412.79, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 38139.26, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 36323.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 36323.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 45403.88, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 36323.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 36323.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 36323.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 37479.62 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 37412.79, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT CCMCC", "code_information": [ { "code": "479", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 45318.0, "minimum": 5613.3, "maximum": 99661.21, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 54382.44, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 45318.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 47584.64, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 43052.77, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 45318.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 45318.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 56648.38, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 63446.18, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 73416.29, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 45318.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 45318.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "case rate", "standard_charge_dollar": 45771.89, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "case rate", "standard_charge_dollar": 70243.99, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 27343.04 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 45318.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link Inc HMO", "methodology": "case rate", "standard_charge_dollar": 21377.35 }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 23025.72 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 45318.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 49850.57, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 45318.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 99661.21 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 45318.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 47584.64, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 47584.64, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 67978.05, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 46678.26, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "case rate", "standard_charge_dollar": 46678.26, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 47584.64, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 45318.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 45318.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 56648.38, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 45318.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 45318.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 45318.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 27343.04 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 46678.26, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "BILIARY TRACT PROCEDURES EXCEPT ONLY CHOLECYSTECTOMY WITH OR WITHOUT C.D.E. WITH CC", "code_information": [ { "code": "409", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 33000.0, "minimum": 7824.6, "maximum": 116731.58, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 39600.96, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 34650.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 31350.76, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 41251.0, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 46201.12, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 53461.3, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "case rate", "standard_charge_dollar": 33330.81, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "case rate", "standard_charge_dollar": 51151.24, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 50146.55 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link Inc HMO", "methodology": "case rate", "standard_charge_dollar": 25038.95 }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 42228.67 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 36300.88, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 116731.58 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 34650.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 34650.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 49501.2, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 33990.82, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "case rate", "standard_charge_dollar": 33990.82, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 34650.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 41251.0, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 50146.55 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 33990.82, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "Blepharoplasty upper eyelid", "code_information": [ { "code": "15822", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8945.0, "discounted_cash": 2200.0, "minimum": 378.91, "maximum": 7156.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 2640.25, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1163.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2200.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 2310.22, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1550.21 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 2090.2, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1550.21 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 2200.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 2200.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 2970.28, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 3080.29, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3564.34, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2200.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2200.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "fee schedule", "standard_charge_dollar": 2200.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 3410.33, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1550.21 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2200.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2530.24, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2200.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1550.21 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2200.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 2420.23, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2200.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 3250.0 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2200.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 2310.22, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1627.72 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2310.22, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3300.32, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1627.72 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2266.22, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 2266.22, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2310.22, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Commercial", "methodology": "fee schedule", "standard_charge_dollar": 378.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2200.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 378.91 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2200.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 2200.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 1549.43 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1550.21 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2200.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2200.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2750.26, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2200.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 2200.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2200.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2266.22, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "CARDIAC DEFIBRILLATOR IMPLANT WITHOUT MCC", "code_information": [ { "code": "277", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 48801.0, "minimum": 5613.3, "maximum": 247611.64, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 58561.32, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 48801.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 51241.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 46361.05, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 48801.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 48801.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 61001.38, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 68321.54, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 79057.78, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 48801.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 48801.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "case rate", "standard_charge_dollar": 49289.11, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "case rate", "standard_charge_dollar": 75641.71, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 48801.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link Inc HMO", "methodology": "case rate", "standard_charge_dollar": 53112.75 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 48801.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 53681.21, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 48801.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 247611.64 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 48801.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 51241.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 51241.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 73201.65, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 50265.13, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "case rate", "standard_charge_dollar": 50265.13, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 51241.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 48801.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 48801.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 61001.38, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 48801.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 48801.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 48801.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 50265.13, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH CC", "code_information": [ { "code": "478", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 45318.0, "minimum": 8845.2, "maximum": 131845.09, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 54382.44, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 45318.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 47584.64, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 43052.77, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 45318.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 45318.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 56648.38, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 63446.18, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 73416.29, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 45318.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 45318.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "case rate", "standard_charge_dollar": 45771.89, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "case rate", "standard_charge_dollar": 70243.99, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 49134.72 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 45318.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link Inc HMO", "methodology": "case rate", "standard_charge_dollar": 28280.8 }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 41376.61 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 45318.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 49850.57, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 45318.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 131845.09 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 45318.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 47584.64, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 47584.64, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 67978.05, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 46678.26, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "case rate", "standard_charge_dollar": 46678.26, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 47584.64, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 45318.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 45318.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 56648.38, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 45318.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 45318.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 45318.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 49134.72 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 46678.26, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "BONE DISEASES AND ARTHROPATHIES WITHOUT MCC", "code_information": [ { "code": "554", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 24697.0, "minimum": 4762.8, "maximum": 44504.15, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 29637.24, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 25932.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 23462.82, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 30872.13, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 34576.78, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 40010.27, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "case rate", "standard_charge_dollar": 24944.68, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "case rate", "standard_charge_dollar": 38281.44, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 12814.57 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link Inc HMO", "methodology": "case rate", "standard_charge_dollar": 9546.15 }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 10791.22 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 27167.47, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 44504.15 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 25932.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 25932.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 37046.55, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 25438.63, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "case rate", "standard_charge_dollar": 25438.63, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 25932.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 30872.13, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 12814.57 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 25438.63, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "Blepharp upr eyelid xcsv skn", "code_information": [ { "code": "15823", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10838.0, "discounted_cash": 2200.0, "minimum": 509.48, "maximum": 8670.4, "payers_information": [ { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2200.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 509.48 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2200.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 2200.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 1549.43 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1550.21 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2200.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2200.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2750.26, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2200.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 2200.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2200.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2266.22, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 2640.25, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1637.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2200.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 2310.22, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1550.21 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 2090.2, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1550.21 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 2200.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 2200.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 2970.28, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 3080.29, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3564.34, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2200.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2200.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "fee schedule", "standard_charge_dollar": 2200.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 3410.33, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1550.21 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2200.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2530.24, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2200.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1550.21 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2200.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 2420.23, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2200.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 5000.0 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2200.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 2310.22, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1627.72 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2310.22, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3300.32, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1627.72 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2266.22, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 2266.22, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2310.22, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Commercial", "methodology": "fee schedule", "standard_charge_dollar": 509.48, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC", "code_information": [ { "code": "477", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 65221.0, "minimum": 14968.8, "maximum": 185211.47, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 78265.8, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 68482.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 61960.43, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 81526.88, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 91310.1, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 105658.83, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "case rate", "standard_charge_dollar": 65873.72, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "case rate", "standard_charge_dollar": 101093.33, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 83358.16 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link Inc HMO", "methodology": "case rate", "standard_charge_dollar": 39727.9 }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 70196.34 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 71743.65, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 185211.47 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 68482.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 68482.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 97832.25, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 67178.15, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "case rate", "standard_charge_dollar": 67178.15, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 68482.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 81526.88, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 83358.16 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 67178.15, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "BREAST BIOPSY, LOCAL EXCISION AND OTHER BREAST PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "585", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 24697.0, "minimum": 3742.2, "maximum": 103424.84, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 29637.24, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 25932.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 23462.82, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 30872.13, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 34576.78, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 40010.27, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "case rate", "standard_charge_dollar": 24944.68, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "case rate", "standard_charge_dollar": 38281.44, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 19753.13 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link Inc HMO", "methodology": "case rate", "standard_charge_dollar": 22184.65 }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 16634.22 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 27167.47, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 103424.84 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 25932.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 25932.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 37046.55, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 25438.63, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "case rate", "standard_charge_dollar": 25438.63, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 25932.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 30872.13, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 19753.13 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 25438.63, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "CARDIAC PACEMAKER DEVICE REPLACEMENT WITH MCC", "code_information": [ { "code": "258", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 65221.0, "minimum": 9120.0, "maximum": 168457.41, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 78265.8, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 68482.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 61960.43, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 81526.88, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 91310.1, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 105658.83, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "case rate", "standard_charge_dollar": 65873.72, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "case rate", "standard_charge_dollar": 101093.33, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 71743.65, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 168457.41 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 68482.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 68482.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 97832.25, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 67178.15, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "case rate", "standard_charge_dollar": 67178.15, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 68482.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 81526.88, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 67178.15, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "BRONCHITIS AND ASTHMA WITH CCMCC", "code_information": [ { "code": "202", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 65221.0, "minimum": 4932.9, "maximum": 105658.83, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 78265.8, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 68482.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 61960.43, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 81526.88, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 91310.1, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 105658.83, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "case rate", "standard_charge_dollar": 65873.72, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "case rate", "standard_charge_dollar": 101093.33, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 14022.83 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link Inc HMO", "methodology": "case rate", "standard_charge_dollar": 11168.8 }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 11808.7 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 71743.65, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 52068.95 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 68482.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 68482.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 97832.25, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 67178.15, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "case rate", "standard_charge_dollar": 67178.15, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 68482.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 81526.88, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 14022.83 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 67178.15, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITH CC", "code_information": [ { "code": "261", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 33000.0, "minimum": 5103.0, "maximum": 101355.38, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 39600.96, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 34650.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 31350.76, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 41251.0, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 46201.12, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 53461.3, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "case rate", "standard_charge_dollar": 33330.81, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "case rate", "standard_charge_dollar": 51151.24, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 25433.46 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 21417.65 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 36300.88, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 101355.38 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 34650.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 34650.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 49501.2, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 33990.82, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "case rate", "standard_charge_dollar": 33990.82, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 34650.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 41251.0, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 25433.46 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 33990.82, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "BREAST BIOPSY, LOCAL EXCISION AND OTHER BREAST PROCEDURES WITH CCMCC", "code_information": [ { "code": "584", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 44119.0, "minimum": 5783.4, "maximum": 114769.35, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 52943.88, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 44119.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 46325.9, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 41913.91, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 44119.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 44119.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 55149.88, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 61767.86, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 71474.24, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 44119.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 44119.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "case rate", "standard_charge_dollar": 44561.1, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "case rate", "standard_charge_dollar": 68385.85, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 22863.18 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 44119.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link Inc HMO", "methodology": "case rate", "standard_charge_dollar": 24618.05 }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 19253.21 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 44119.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 48531.89, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 44119.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 114769.35 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 44119.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 46325.9, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 46325.9, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 66179.85, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 45443.5, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "case rate", "standard_charge_dollar": 45443.5, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 46325.9, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 44119.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 44119.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 55149.88, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 44119.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 44119.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 44119.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 22863.18 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 45443.5, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITH MCC", "code_information": [ { "code": "260", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 48801.0, "minimum": 9695.7, "maximum": 174392.37, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 58561.32, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 48801.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 51241.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 46361.05, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 48801.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 48801.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 61001.38, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 68321.54, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 79057.78, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 48801.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 48801.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "case rate", "standard_charge_dollar": 49289.11, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "case rate", "standard_charge_dollar": 75641.71, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 61367.7 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 48801.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 51678.06 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 48801.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 53681.21, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 48801.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 174392.37 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 48801.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 51241.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 51241.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 73201.65, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 50265.13, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "case rate", "standard_charge_dollar": 50265.13, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 51241.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 48801.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 48801.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 61001.38, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 48801.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 48801.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 48801.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 61367.7 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 50265.13, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "CARDIAC ARREST, UNEXPLAINED WITHOUT CCMCC", "code_information": [ { "code": "298", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 28231.0, "minimum": 1871.1, "maximum": 45735.516, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 33878.16, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 28231.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 29643.39, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 26820.21, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 28231.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 28231.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 35289.75, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 39524.52, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 45735.52, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 28231.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 28231.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "case rate", "standard_charge_dollar": 28514.12, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "case rate", "standard_charge_dollar": 43759.29, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 15425.44 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 28231.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link Inc HMO", "methodology": "case rate", "standard_charge_dollar": 5233.65 }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 12989.85 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 28231.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 31054.98, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 28231.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 24399.28 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 28231.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 29643.39, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 29643.39, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 42347.7, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 29078.75, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "case rate", "standard_charge_dollar": 29078.75, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 29643.39, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 28231.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 28231.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 35289.75, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 28231.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 28231.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 28231.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 15425.44 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 29078.75, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITHOUT CCMCC", "code_information": [ { "code": "262", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 24697.0, "minimum": 3402.0, "maximum": 87383.83, "payers_information": [ { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 25438.63, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "case rate", "standard_charge_dollar": 25438.63, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 25932.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 30872.13, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 18182.1 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 25438.63, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 29637.24, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 25932.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 23462.82, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 30872.13, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 34576.78, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 40010.27, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "case rate", "standard_charge_dollar": 24944.68, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "case rate", "standard_charge_dollar": 38281.44, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 18182.1 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 15311.24 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 27167.47, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 87383.83 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 25932.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 25932.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 37046.55, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITH MCC", "code_information": [ { "code": "216", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 65221.0, "minimum": 20330.0, "maximum": 524485.26, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 78265.8, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 68482.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 61960.43, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 81526.88, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 91310.1, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 105658.83, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "case rate", "standard_charge_dollar": 65873.72, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "case rate", "standard_charge_dollar": 101093.33, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 230315.95 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link Inc HMO", "methodology": "case rate", "standard_charge_dollar": 112502.2 }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 193950.27 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 71743.65, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 524485.26 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 68482.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 68482.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 97832.25, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 67178.15, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "case rate", "standard_charge_dollar": 67178.15, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 68482.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 81526.88, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 230315.95 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 67178.15, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITH MCC", "code_information": [ { "code": "308", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 43257.0, "minimum": 5783.4, "maximum": 70076.502, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 51908.52, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 43257.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 45419.96, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 41094.25, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 43257.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 43257.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 54071.38, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 60559.94, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 70076.5, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 43257.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 43257.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "case rate", "standard_charge_dollar": 43689.67, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "case rate", "standard_charge_dollar": 67048.51, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 31469.46 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 43257.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link Inc HMO", "methodology": "case rate", "standard_charge_dollar": 13846.0 }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 26500.6 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 43257.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 47582.81, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 43257.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 64550.05 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 43257.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 45419.96, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 45419.96, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 64885.65, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 44554.81, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "case rate", "standard_charge_dollar": 44554.81, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 45419.96, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 43257.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 43257.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 54071.38, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 43257.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 43257.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 43257.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 31469.46 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 44554.81, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "CAROTID ARTERY STENT PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "036", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 65221.0, "minimum": 2041.2, "maximum": 105658.83, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 78265.8, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 68482.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 61960.43, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 81526.88, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 91310.1, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 105658.83, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "case rate", "standard_charge_dollar": 65873.72, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "case rate", "standard_charge_dollar": 101093.33, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link Inc HMO", "methodology": "case rate", "standard_charge_dollar": 22342.2 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 71743.65, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 104159.34 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 68482.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 68482.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 97832.25, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 67178.15, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "case rate", "standard_charge_dollar": 67178.15, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 68482.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 81526.88, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 67178.15, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETERIZATION WITHOUT CCMCC", "code_information": [ { "code": "221", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 65221.0, "minimum": 5890.0, "maximum": 270220.24, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 78265.8, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 68482.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 61960.43, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 81526.88, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 91310.1, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 105658.83, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "case rate", "standard_charge_dollar": 65873.72, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "case rate", "standard_charge_dollar": 101093.33, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 72600.56 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link Inc HMO", "methodology": "case rate", "standard_charge_dollar": 57962.3 }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 61137.31 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 71743.65, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 270220.24 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 68482.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 68482.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 97832.25, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 67178.15, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "case rate", "standard_charge_dollar": 67178.15, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 68482.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 81526.88, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 72600.56 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 67178.15, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "CARDIAC ARREST, UNEXPLAINED WITH CC", "code_information": [ { "code": "297", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 28231.0, "minimum": 2211.3, "maximum": 45735.516, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 33878.16, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 28231.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 29643.39, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 26820.21, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 28231.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 28231.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 35289.75, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 39524.52, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 45735.52, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 28231.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 28231.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "case rate", "standard_charge_dollar": 28514.12, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "case rate", "standard_charge_dollar": 43759.29, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 24394.4 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 28231.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link Inc HMO", "methodology": "case rate", "standard_charge_dollar": 7291.0 }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 20542.66 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 28231.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 31054.98, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 28231.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 33990.64 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 28231.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 29643.39, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 29643.39, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 42347.7, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 29078.75, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "case rate", "standard_charge_dollar": 29078.75, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 29643.39, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 28231.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 28231.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 35289.75, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 28231.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 28231.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 28231.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 24394.4 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 29078.75, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "CARDIAC CONGENITAL AND VALVULAR DISORDERS WITH MCC", "code_information": [ { "code": "306", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 48801.0, "minimum": 6633.9, "maximum": 84483.37, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 58561.32, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 48801.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 51241.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 46361.05, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 48801.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 48801.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 61001.38, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 68321.54, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 79057.78, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 48801.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 48801.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "case rate", "standard_charge_dollar": 49289.11, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "case rate", "standard_charge_dollar": 75641.71, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 45818.51 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 48801.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link Inc HMO", "methodology": "case rate", "standard_charge_dollar": 18121.7 }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 38584.01 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 48801.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 53681.21, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 48801.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 84483.37 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 48801.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 51241.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 51241.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 73201.65, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 50265.13, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "case rate", "standard_charge_dollar": 50265.13, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 51241.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 48801.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 48801.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 61001.38, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 48801.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 48801.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 48801.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 45818.51 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 50265.13, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "CARDIAC ARREST, UNEXPLAINED WITH MCC", "code_information": [ { "code": "296", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 39759.0, "minimum": 3402.0, "maximum": 83738.14, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 47710.92, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 39759.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 41747.06, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 37771.15, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 39759.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 39759.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 49698.88, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 55662.74, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 64409.74, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 39759.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 39759.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "case rate", "standard_charge_dollar": 40156.69, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "case rate", "standard_charge_dollar": 61626.61, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 34997.97 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 39759.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link Inc HMO", "methodology": "case rate", "standard_charge_dollar": 17961.85 }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 29471.98 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 39759.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 43735.01, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 39759.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 83738.14 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 39759.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 41747.06, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 41747.06, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 59638.65, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 40951.87, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "case rate", "standard_charge_dollar": 40951.87, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 41747.06, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 39759.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 39759.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 49698.88, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 39759.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 39759.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 39759.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 34997.97 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 40951.87, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "CARDIAC DEFIBRILLATOR IMPLANT WITH MCC", "code_information": [ { "code": "276", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 48801.0, "minimum": 10546.2, "maximum": 322031.85, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 58561.32, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 48801.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 51241.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 46361.05, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 48801.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 48801.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 61001.38, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 68321.54, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 79057.78, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 48801.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 48801.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "case rate", "standard_charge_dollar": 49289.11, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "case rate", "standard_charge_dollar": 75641.71, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 48801.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link Inc HMO", "methodology": "case rate", "standard_charge_dollar": 69075.9 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 48801.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 53681.21, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 48801.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 322031.85 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 48801.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 51241.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 51241.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 73201.65, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 50265.13, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "case rate", "standard_charge_dollar": 50265.13, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 51241.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 48801.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 48801.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 61001.38, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 48801.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 48801.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 48801.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 50265.13, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "CARDIAC PACEMAKER DEVICE REPLACEMENT WITHOUT MCC", "code_information": [ { "code": "259", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 24697.0, "minimum": 4560.0, "maximum": 108410.85, "payers_information": [ { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 30872.13, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 24747.27 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 25438.63, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 29637.24, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 25932.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 23462.82, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 30872.13, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 34576.78, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 40010.27, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "case rate", "standard_charge_dollar": 24944.68, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "case rate", "standard_charge_dollar": 38281.44, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 24747.27 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 20839.81 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 27167.47, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 108410.85 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 25932.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 25932.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 37046.55, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 25438.63, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "case rate", "standard_charge_dollar": 25438.63, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 25932.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "CELLULITIS WITH MCC", "code_information": [ { "code": "602", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 37186.0, "minimum": 7824.6, "maximum": 76200.16, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 44623.2, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 37186.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 39045.3, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 35326.7, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 37186.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 37186.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 46482.5, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 52060.4, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 60241.32, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 37186.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 37186.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "case rate", "standard_charge_dollar": 37557.86, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "case rate", "standard_charge_dollar": 57638.3, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 31352.94 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 37186.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link Inc HMO", "methodology": "case rate", "standard_charge_dollar": 16344.95 }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 26402.47 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 37186.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 40904.6, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 37186.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 76200.16 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 37186.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 39045.3, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 39045.3, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 55779.0, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 38301.58, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "case rate", "standard_charge_dollar": 38301.58, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 39045.3, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 37186.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 37186.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 46482.5, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 37186.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 37186.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 37186.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 31352.94 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 38301.58, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITH CC", "code_information": [ { "code": "309", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 24697.0, "minimum": 3912.3, "maximum": 40010.274, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 29637.24, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 25932.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 23462.82, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 30872.13, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 34576.78, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 40010.27, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "case rate", "standard_charge_dollar": 24944.68, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "case rate", "standard_charge_dollar": 38281.44, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 17344.25 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link Inc HMO", "methodology": "case rate", "standard_charge_dollar": 8460.55 }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 14605.69 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 27167.47, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 39443.08 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 25932.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 25932.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 37046.55, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 25438.63, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "case rate", "standard_charge_dollar": 25438.63, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 25932.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 30872.13, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 17344.25 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 25438.63, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITHOUT CCMCC", "code_information": [ { "code": "310", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 24697.0, "minimum": 3061.8, "maximum": 40010.274, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 29637.24, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 25932.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 23462.82, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 30872.13, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 34576.78, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 40010.27, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "case rate", "standard_charge_dollar": 24944.68, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "case rate", "standard_charge_dollar": 38281.44, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 11940.54 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link Inc HMO", "methodology": "case rate", "standard_charge_dollar": 6510.15 }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 10055.19 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 27167.47, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 30350.32 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 25932.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 25932.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 37046.55, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 25438.63, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "case rate", "standard_charge_dollar": 25438.63, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 25932.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 30872.13, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 11940.54 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 25438.63, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITH CC", "code_information": [ { "code": "217", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 65221.0, "minimum": 9880.0, "maximum": 352521.56, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 78265.8, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 68482.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 61960.43, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 81526.88, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 91310.1, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 105658.83, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "case rate", "standard_charge_dollar": 65873.72, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "case rate", "standard_charge_dollar": 101093.33, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 118143.5 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link Inc HMO", "methodology": "case rate", "standard_charge_dollar": 75615.95 }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 99489.26 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 71743.65, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 352521.56 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 68482.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 68482.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 97832.25, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 67178.15, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "case rate", "standard_charge_dollar": 67178.15, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 68482.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 81526.88, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 118143.5 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 67178.15, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "CESAREAN SECTION WITH STERILIZATION WITH MCC", "code_information": [ { "code": "783", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 65221.0, "minimum": 4166.0, "maximum": 131625.28, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 78265.8, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 68482.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 61960.43, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 81526.88, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 91310.1, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 105658.83, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "case rate", "standard_charge_dollar": 65873.72, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "case rate", "standard_charge_dollar": 101093.33, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link Inc HMO", "methodology": "case rate", "standard_charge_dollar": 28233.65 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 71743.65, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 131625.28 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 68482.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 68482.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 97832.25, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 67178.15, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "case rate", "standard_charge_dollar": 67178.15, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 68482.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 81526.88, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 67178.15, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETERIZATION WITH MCC", "code_information": [ { "code": "219", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 65221.0, "minimum": 16150.0, "maximum": 411656.7, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 78265.8, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 68482.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 61960.43, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 81526.88, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 91310.1, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 105658.83, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "case rate", "standard_charge_dollar": 65873.72, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "case rate", "standard_charge_dollar": 101093.33, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 147053.16 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link Inc HMO", "methodology": "case rate", "standard_charge_dollar": 88300.45 }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 123834.24 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 71743.65, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 411656.7 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 68482.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 68482.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 97832.25, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 67178.15, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "case rate", "standard_charge_dollar": 67178.15, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 68482.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 81526.88, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 147053.16 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 67178.15, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "CESAREAN SECTION WITH STERILIZATION WITHOUT CCMCC", "code_information": [ { "code": "785", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 33000.0, "minimum": 4750.0, "maximum": 53461.296, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 39600.96, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 34650.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 31350.76, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 41251.0, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 46201.12, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 53461.3, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "case rate", "standard_charge_dollar": 33330.81, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "case rate", "standard_charge_dollar": 51151.24, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link Inc HMO", "methodology": "case rate", "standard_charge_dollar": 11014.7 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 36300.88, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 51350.53 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 34650.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 34650.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 49501.2, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 33990.82, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "case rate", "standard_charge_dollar": 33990.82, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 34650.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 41251.0, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 33990.82, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "CARDIAC CONGENITAL AND VALVULAR DISORDERS WITHOUT MCC", "code_information": [ { "code": "307", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 33000.0, "minimum": 3742.2, "maximum": 53461.296, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 39600.96, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 34650.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 31350.76, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 41251.0, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 46201.12, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 53461.3, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "case rate", "standard_charge_dollar": 33330.81, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "case rate", "standard_charge_dollar": 51151.24, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 15827.45 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link Inc HMO", "methodology": "case rate", "standard_charge_dollar": 10501.8 }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 13328.38 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 36300.88, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 48959.39 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 34650.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 34650.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 49501.2, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 33990.82, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "case rate", "standard_charge_dollar": 33990.82, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 34650.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 41251.0, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 15827.45 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 33990.82, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "CESAREAN SECTION WITHOUT STERILIZATION WITH MCC", "code_information": [ { "code": "786", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 65221.0, "minimum": 6249.0, "maximum": 105658.83, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 78265.8, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 68482.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 61960.43, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 81526.88, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 91310.1, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 105658.83, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "case rate", "standard_charge_dollar": 65873.72, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "case rate", "standard_charge_dollar": 101093.33, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link Inc HMO", "methodology": "case rate", "standard_charge_dollar": 18969.25 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 71743.65, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 88434.64 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 68482.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 68482.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 97832.25, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 67178.15, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "case rate", "standard_charge_dollar": 67178.15, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 68482.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 81526.88, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 67178.15, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "CARDIAC DEFIBRILLATOR IMPLANT WITH CARDIAC CATHETERIZATION AND MCC", "code_information": [ { "code": "275", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 65221.0, "minimum": 14118.3, "maximum": 382282.14, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 78265.8, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 68482.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 61960.43, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 81526.88, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 91310.1, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 105658.83, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "case rate", "standard_charge_dollar": 65873.72, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "case rate", "standard_charge_dollar": 101093.33, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link Inc HMO", "methodology": "case rate", "standard_charge_dollar": 81999.6 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 71743.65, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 382282.14 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 68482.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 68482.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 97832.25, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 67178.15, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "case rate", "standard_charge_dollar": 67178.15, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 68482.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 81526.88, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 67178.15, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "CHEST PAIN", "code_information": [ { "code": "313", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 35212.0, "minimum": 2891.7, "maximum": 57043.926, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 42254.76, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 36972.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 33451.69, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 44015.38, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 49297.22, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 57043.93, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "case rate", "standard_charge_dollar": 35564.42, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "case rate", "standard_charge_dollar": 54579.07, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 10616.81 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link Inc HMO", "methodology": "case rate", "standard_charge_dollar": 8280.0 }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 8940.47 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 38733.53, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 38601.36 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 36972.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 36972.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 52818.45, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 36268.67, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "case rate", "standard_charge_dollar": 36268.67, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 36972.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 44015.38, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 10616.81 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 36268.67, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH MCC", "code_information": [ { "code": "846", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 35212.0, "minimum": 10206.0, "maximum": 138991.7, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 42254.76, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 36972.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 33451.69, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 44015.38, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 49297.22, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 57043.93, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "case rate", "standard_charge_dollar": 35564.42, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "case rate", "standard_charge_dollar": 54579.07, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link Inc HMO", "methodology": "case rate", "standard_charge_dollar": 29813.75 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 38733.53, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 138991.7 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 36972.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 36972.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 52818.45, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 36268.67, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "case rate", "standard_charge_dollar": 36268.67, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 36972.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 44015.38, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 36268.67, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "CHIMERIC ANTIGEN RECEPTOR (CAR) T-CELL AND OTHER IMMUNOTHERAPIES", "code_information": [ { "code": "018", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 24697.0, "minimum": 20922.3, "maximum": 2315159.46, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 29637.24, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 25932.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 23462.82, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 30872.13, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 34576.78, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 40010.27, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "case rate", "standard_charge_dollar": 24944.68, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "case rate", "standard_charge_dollar": 38281.44, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link Inc HMO", "methodology": "case rate", "standard_charge_dollar": 496602.2 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 27167.47, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 2315159.46 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 25932.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 25932.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 37046.55, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 25438.63, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "case rate", "standard_charge_dollar": 25438.63, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 25932.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 30872.13, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 25438.63, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "CAROTID ARTERY STENT PROCEDURES WITH MCC", "code_information": [ { "code": "034", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 65221.0, "minimum": 7994.7, "maximum": 207519.84, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 78265.8, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 68482.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 61960.43, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 81526.88, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 91310.1, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 105658.83, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "case rate", "standard_charge_dollar": 65873.72, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "case rate", "standard_charge_dollar": 101093.33, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link Inc HMO", "methodology": "case rate", "standard_charge_dollar": 44513.05 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 71743.65, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 207519.84 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 68482.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 68482.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 97832.25, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 67178.15, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "case rate", "standard_charge_dollar": 67178.15, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 68482.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 81526.88, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 67178.15, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITHOUT CCMCC", "code_information": [ { "code": "218", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 65221.0, "minimum": 4370.0, "maximum": 352521.56, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 78265.8, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 68482.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 61960.43, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 81526.88, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 91310.1, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 105658.83, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "case rate", "standard_charge_dollar": 65873.72, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "case rate", "standard_charge_dollar": 101093.33, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 101202.29 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link Inc HMO", "methodology": "case rate", "standard_charge_dollar": 75615.95 }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 85222.98 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 71743.65, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 352521.56 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 68482.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 68482.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 97832.25, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 67178.15, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "case rate", "standard_charge_dollar": 67178.15, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 68482.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 81526.88, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 101202.29 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 67178.15, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITH MCC", "code_information": [ { "code": "414", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 49483.0, "minimum": 12927.6, "maximum": 191001.67, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 59379.84, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 49483.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 51957.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 47009.04, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 49483.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 49483.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 61854.0, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 69276.48, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 80162.78, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 49483.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 49483.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "case rate", "standard_charge_dollar": 49978.03, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "case rate", "standard_charge_dollar": 76698.96, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 67118.72 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 49483.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link Inc HMO", "methodology": "case rate", "standard_charge_dollar": 40969.9 }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 56521.02 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 49483.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 54431.52, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 49483.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 191001.67 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 49483.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 51957.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 51957.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 74224.8, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 50967.7, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "case rate", "standard_charge_dollar": 50967.7, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 51957.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 49483.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 49483.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 61854.0, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 49483.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 49483.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 49483.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 67118.72 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 50967.7, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETERIZATION WITH CC", "code_information": [ { "code": "220", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 65221.0, "minimum": 10640.0, "maximum": 285907.41, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 78265.8, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 68482.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 61960.43, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 81526.88, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 91310.1, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 105658.83, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "case rate", "standard_charge_dollar": 65873.72, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "case rate", "standard_charge_dollar": 101093.33, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 94913.59 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link Inc HMO", "methodology": "case rate", "standard_charge_dollar": 61327.2 }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 79927.23 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 71743.65, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 285907.41 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 68482.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 68482.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 97832.25, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 67178.15, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "case rate", "standard_charge_dollar": 67178.15, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 68482.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 81526.88, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 94913.59 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 67178.15, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITH CC", "code_information": [ { "code": "415", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 37155.0, "minimum": 7654.5, "maximum": 110801.99, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 44586.0, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 37155.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 39012.75, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 35297.25, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 37155.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 37155.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 46443.75, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 52017.0, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 60191.1, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 37155.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 37155.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "case rate", "standard_charge_dollar": 37526.55, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "case rate", "standard_charge_dollar": 57590.25, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 41408.61 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 37155.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link Inc HMO", "methodology": "case rate", "standard_charge_dollar": 23767.05 }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 34870.41 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 37155.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 40870.5, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 37155.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 110801.99 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 37155.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 39012.75, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 39012.75, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 55732.5, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 38269.65, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "case rate", "standard_charge_dollar": 38269.65, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 39012.75, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 37155.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 37155.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 46443.75, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 37155.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 37155.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 37155.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 41408.61 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 38269.65, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITHOUT CCMCC", "code_information": [ { "code": "416", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 37155.0, "minimum": 4762.8, "maximum": 73090.6, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 46443.75, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 52017.0, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 60191.1, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 37155.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 37155.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "case rate", "standard_charge_dollar": 37526.55, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "case rate", "standard_charge_dollar": 57590.25, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 28948.15 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 37155.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link Inc HMO", "methodology": "case rate", "standard_charge_dollar": 15677.95 }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 24377.39 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 37155.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 40870.5, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 37155.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 73090.6 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 37155.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 39012.75, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 39012.75, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 55732.5, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 38269.65, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "case rate", "standard_charge_dollar": 38269.65, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 39012.75, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 37155.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 37155.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 46443.75, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 37155.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 37155.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 37155.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 28948.15 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 38269.65, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 44586.0, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 37155.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 39012.75, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 35297.25, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 37155.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 37155.0, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "CERVICAL SPINAL FUSION WITH MCC", "code_information": [ { "code": "471", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 36323.0, "minimum": 12077.1, "maximum": 258881.09, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 43587.72, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 36323.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 38139.26, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 34506.95, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 36323.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 36323.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 45403.88, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 50852.34, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 58843.42, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 36323.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 36323.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "case rate", "standard_charge_dollar": 36686.33, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "case rate", "standard_charge_dollar": 56300.81, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 91574.67 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 36323.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link Inc HMO", "methodology": "case rate", "standard_charge_dollar": 55530.05 }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 77115.51 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 36323.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 39955.41, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 36323.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 258881.09 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 36323.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 38139.26, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 38139.26, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 54484.65, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 37412.79, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "case rate", "standard_charge_dollar": 37412.79, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 38139.26, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 36323.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 36323.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 45403.88, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 36323.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 36323.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 36323.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 91574.67 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 37412.79, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "CIRRHOSIS AND ALCOHOLIC HEPATITIS WITHOUT CCMCC", "code_information": [ { "code": "434", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 24697.0, "minimum": 3572.1, "maximum": 40010.274, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 29637.24, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 25932.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 23462.82, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 30872.13, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 34576.78, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 40010.27, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "case rate", "standard_charge_dollar": 24944.68, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "case rate", "standard_charge_dollar": 38281.44, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 14495.81 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link Inc HMO", "methodology": "case rate", "standard_charge_dollar": 8193.75 }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 12207.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 27167.47, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 38199.26 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 25932.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 25932.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 37046.55, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 25438.63, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "case rate", "standard_charge_dollar": 25438.63, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 25932.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 30872.13, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 14495.81 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 25438.63, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "CAROTID ARTERY STENT PROCEDURES WITH CC", "code_information": [ { "code": "035", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 65221.0, "minimum": 3231.9, "maximum": 128161.88, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 78265.8, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 68482.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 61960.43, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 81526.88, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 91310.1, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 105658.83, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "case rate", "standard_charge_dollar": 65873.72, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "case rate", "standard_charge_dollar": 101093.33, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link Inc HMO", "methodology": "case rate", "standard_charge_dollar": 27490.75 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 71743.65, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 128161.88 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 68482.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 68482.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 97832.25, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 67178.15, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "case rate", "standard_charge_dollar": 67178.15, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 68482.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 81526.88, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 67178.15, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "CESAREAN SECTION WITHOUT STERILIZATION WITHOUT CCMCC", "code_information": [ { "code": "788", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 33000.0, "minimum": 5510.0, "maximum": 53461.296, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 39600.96, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 34650.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 31350.76, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 41251.0, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 46201.12, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 53461.3, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "case rate", "standard_charge_dollar": 33330.81, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "case rate", "standard_charge_dollar": 51151.24, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link Inc HMO", "methodology": "case rate", "standard_charge_dollar": 11026.2 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 36300.88, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 51404.14 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 34650.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 34650.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 49501.2, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 33990.82, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "case rate", "standard_charge_dollar": 33990.82, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 34650.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 41251.0, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 33990.82, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH CC", "code_information": [ { "code": "191", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 33765.0, "minimum": 4592.7, "maximum": 54700.11, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 40518.6, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 33765.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 35453.78, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 32077.23, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 33765.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 33765.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 42206.88, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 47271.7, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 54700.11, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 33765.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 33765.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "case rate", "standard_charge_dollar": 34103.16, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "case rate", "standard_charge_dollar": 52336.53, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 21404.25 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 33765.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link Inc HMO", "methodology": "case rate", "standard_charge_dollar": 9694.5 }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 18024.63 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 33765.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 37142.05, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 33765.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 45195.76 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 33765.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 35453.78, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 35453.78, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 50648.25, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 34778.47, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "case rate", "standard_charge_dollar": 34778.47, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 35453.78, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 33765.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 33765.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 42206.88, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 33765.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 33765.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 33765.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 21404.25 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 34778.47, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "COAGULATION DISORDERS", "code_information": [ { "code": "813", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 35212.0, "minimum": 6123.6, "maximum": 81775.91, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 42254.76, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 36972.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 33451.69, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 44015.38, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 49297.22, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 57043.93, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "case rate", "standard_charge_dollar": 35564.42, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "case rate", "standard_charge_dollar": 54579.07, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 18887.51 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link Inc HMO", "methodology": "case rate", "standard_charge_dollar": 17540.95 }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 15905.27 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 38733.53, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 81775.91 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 36972.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 36972.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 52818.45, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 36268.67, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "case rate", "standard_charge_dollar": 36268.67, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 36972.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 44015.38, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 18887.51 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 36268.67, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITHOUT CCMCC", "code_information": [ { "code": "848", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 24697.0, "minimum": 4592.7, "maximum": 45538.88, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 29637.24, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 25932.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 23462.82, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 30872.13, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 34576.78, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 40010.27, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "case rate", "standard_charge_dollar": 24944.68, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "case rate", "standard_charge_dollar": 38281.44, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link Inc HMO", "methodology": "case rate", "standard_charge_dollar": 9768.1 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 27167.47, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 45538.88 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 25932.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 25932.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 37046.55, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 25438.63, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "case rate", "standard_charge_dollar": 25438.63, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 25932.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 30872.13, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 25438.63, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "CIRCULATORY DISORDERS EXCEPT AMI, WITH CARDIAC CATHETERIZATION WITHOUT MCC", "code_information": [ { "code": "287", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 35212.0, "minimum": 3990.0, "maximum": 57371.27, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 42254.76, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 36972.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 33451.69, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 44015.38, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 49297.22, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 57043.93, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "case rate", "standard_charge_dollar": 35564.42, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "case rate", "standard_charge_dollar": 54579.07, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 29366.76 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link Inc HMO", "methodology": "case rate", "standard_charge_dollar": 12306.15 }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 24729.9 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 38733.53, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 57371.27 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 36972.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 36972.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 52818.45, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 36268.67, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "case rate", "standard_charge_dollar": 36268.67, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 36972.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 44015.38, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 29366.76 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 36268.67, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "CHOLECYSTECTOMY WITH C.D.E. WITH MCC", "code_information": [ { "code": "411", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 49483.0, "minimum": 9695.7, "maximum": 177099.82, "payers_information": [ { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "case rate", "standard_charge_dollar": 49978.03, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "case rate", "standard_charge_dollar": 76698.96, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 61277.4 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 49483.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link Inc HMO", "methodology": "case rate", "standard_charge_dollar": 37987.95 }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 51602.02 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 49483.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 54431.52, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 49483.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 177099.82 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 49483.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 51957.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 51957.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 74224.8, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 50967.7, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "case rate", "standard_charge_dollar": 50967.7, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 51957.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 49483.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 49483.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 61854.0, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 49483.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 49483.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 49483.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 61277.4 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 50967.7, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 59379.84, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 49483.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 51957.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 47009.04, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 49483.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 49483.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 61854.0, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 69276.48, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 80162.78, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 49483.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 49483.2, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Cmplx rpr trunk 2.6-7.5 cm", "code_information": [ { "code": "13101", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8528.0, "discounted_cash": 788.0, "minimum": 228.6, "maximum": 6822.4, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 945.74, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1163.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 788.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 827.53, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 364.62 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 748.71, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 364.62 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 788.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 788.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 1063.96, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 1103.37, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1276.75, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 788.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 788.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "fee schedule", "standard_charge_dollar": 788.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 1221.59, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 364.62 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 788.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 906.34, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Medicare", "methodology": "fee schedule", "standard_charge_dollar": 788.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 364.62 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 788.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 866.93, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 788.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 3250.0 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 788.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 827.53, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 382.85 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 827.53, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1182.18, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 382.85 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 811.76, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 811.76, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 827.53, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Commercial", "methodology": "fee schedule", "standard_charge_dollar": 228.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 788.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 228.6 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 788.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 788.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 364.44 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 364.62 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 788.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 788.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 985.15, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 788.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 788.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 788.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 811.76, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "CHOLECYSTECTOMY WITH C.D.E. WITHOUT CCMCC", "code_information": [ { "code": "413", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 33000.0, "minimum": 4762.8, "maximum": 89024.39, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 39600.96, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 34650.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 31350.76, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 41251.0, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 46201.12, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 53461.3, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "case rate", "standard_charge_dollar": 33330.81, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "case rate", "standard_charge_dollar": 51151.24, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 37755.24 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link Inc HMO", "methodology": "case rate", "standard_charge_dollar": 19095.75 }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 31793.89 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 36300.88, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 89024.39 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 34650.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 34650.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 49501.2, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 33990.82, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "case rate", "standard_charge_dollar": 33990.82, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 34650.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 41251.0, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 37755.24 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 33990.82, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "COMPLICATED PEPTIC ULCER WITH CC", "code_information": [ { "code": "381", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 35212.0, "minimum": 5443.2, "maximum": 58089.69, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 42254.76, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 36972.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 33451.69, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 44015.38, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 49297.22, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 57043.93, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "case rate", "standard_charge_dollar": 35564.42, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "case rate", "standard_charge_dollar": 54579.07, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 22639.79 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link Inc HMO", "methodology": "case rate", "standard_charge_dollar": 12460.25 }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 19065.09 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 38733.53, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 58089.69 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 36972.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 36972.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 52818.45, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 36268.67, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "case rate", "standard_charge_dollar": 36268.67, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 36972.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 44015.38, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 22639.79 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 36268.67, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "CELLULITIS WITHOUT MCC", "code_information": [ { "code": "603", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 24878.0, "minimum": 5273.1, "maximum": 46691.56, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 29854.2, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 24878.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 26122.43, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 23634.58, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 24878.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 24878.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 31098.13, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 34829.9, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 40303.17, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 24878.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 24878.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "case rate", "standard_charge_dollar": 25127.29, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "case rate", "standard_charge_dollar": 38561.68, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 12007.57 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 24878.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link Inc HMO", "methodology": "case rate", "standard_charge_dollar": 10015.35 }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 10111.64 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 24878.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 27366.35, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 24878.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 46691.56 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 24878.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 26122.43, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 26122.43, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 37317.75, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 25624.86, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "case rate", "standard_charge_dollar": 25624.86, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 26122.43, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 24878.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 24878.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 31098.13, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 24878.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 24878.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 24878.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 12007.57 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 25624.86, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "COMPLICATIONS OF TREATMENT WITHOUT CCMCC", "code_information": [ { "code": "921", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 35212.0, "minimum": 3572.1, "maximum": 57043.926, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 42254.76, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 36972.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 33451.69, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 44015.38, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 49297.22, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 57043.93, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "case rate", "standard_charge_dollar": 35564.42, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "case rate", "standard_charge_dollar": 54579.07, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 12306.48 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link Inc HMO", "methodology": "case rate", "standard_charge_dollar": 7916.6 }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 10363.35 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 38733.53, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 36907.19 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 36972.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 36972.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 52818.45, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 36268.67, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "case rate", "standard_charge_dollar": 36268.67, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 36972.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 44015.38, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 12306.48 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 36268.67, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "CERVICAL SPINAL FUSION WITH CC", "code_information": [ { "code": "472", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 36323.0, "minimum": 4252.5, "maximum": 157949.26, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 43587.72, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 36323.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 38139.26, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 34506.95, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 36323.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 36323.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 45403.88, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 50852.34, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 58843.42, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 36323.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 36323.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "case rate", "standard_charge_dollar": 36686.33, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "case rate", "standard_charge_dollar": 56300.81, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 33438.51 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 36323.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link Inc HMO", "methodology": "case rate", "standard_charge_dollar": 33880.15 }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 28158.74 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 36323.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 39955.41, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 36323.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 157949.26 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 36323.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 38139.26, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 38139.26, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 54484.65, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 37412.79, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "case rate", "standard_charge_dollar": 37412.79, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 38139.26, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 36323.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 36323.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 45403.88, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 36323.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 36323.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 36323.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 33438.51 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 37412.79, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "COMPLICATED PEPTIC ULCER WITH MCC", "code_information": [ { "code": "380", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 49483.0, "minimum": 8505.0, "maximum": 105199.43, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 59379.84, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 49483.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 51957.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 47009.04, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 49483.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 49483.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 61854.0, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 69276.48, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 80162.78, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 49483.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 49483.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "case rate", "standard_charge_dollar": 49978.03, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "case rate", "standard_charge_dollar": 76698.96, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 37288.92 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 49483.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link Inc HMO", "methodology": "case rate", "standard_charge_dollar": 22565.3 }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 31401.19 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 49483.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 54431.52, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 49483.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 105199.43 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 49483.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 51957.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 51957.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 74224.8, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 50967.7, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "case rate", "standard_charge_dollar": 50967.7, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 51957.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 49483.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 49483.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 61854.0, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 49483.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 49483.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 49483.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 37288.92 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 50967.7, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "CONCUSSION WITH CC", "code_information": [ { "code": "089", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 32515.0, "minimum": 4252.5, "maximum": 58899.24, "payers_information": [ { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 32515.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 18456.36 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 33490.66, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 39018.24, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 32515.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 34140.96, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 30889.44, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 32515.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 32515.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 40644.0, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 45521.28, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 52674.62, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 32515.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 32515.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "case rate", "standard_charge_dollar": 32840.35, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "case rate", "standard_charge_dollar": 50398.56, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 18456.36 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 32515.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link Inc HMO", "methodology": "case rate", "standard_charge_dollar": 12633.9 }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 15542.2 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 32515.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 35766.72, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 32515.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 58899.24 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 32515.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 34140.96, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 34140.96, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 48772.8, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 33490.66, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "case rate", "standard_charge_dollar": 33490.66, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 34140.96, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 32515.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 32515.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 40644.0, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 32515.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 32515.2, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "CERVICAL SPINAL FUSION WITHOUT CCMCC", "code_information": [ { "code": "473", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 36323.0, "minimum": 2721.6, "maximum": 130885.42, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 43587.72, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 36323.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 38139.26, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 34506.95, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 36323.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 36323.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 45403.88, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 50852.34, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 58843.42, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 36323.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 36323.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "case rate", "standard_charge_dollar": 36686.33, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "case rate", "standard_charge_dollar": 56300.81, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 28069.11 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 36323.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link Inc HMO", "methodology": "case rate", "standard_charge_dollar": 28074.95 }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 23637.14 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 36323.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 39955.41, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 36323.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 130885.42 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 36323.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 38139.26, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 38139.26, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 54484.65, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 37412.79, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "case rate", "standard_charge_dollar": 37412.79, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 38139.26, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 36323.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 36323.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 45403.88, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 36323.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 36323.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 36323.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 28069.11 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 37412.79, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "CONCOMITANT AORTIC AND MITRAL VALVE PROCEDURES", "code_information": [ { "code": "212", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 65221.0, "minimum": 21262.5, "maximum": 582993.12, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 78265.8, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 68482.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 61960.43, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 81526.88, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 91310.1, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 105658.83, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "case rate", "standard_charge_dollar": 65873.72, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "case rate", "standard_charge_dollar": 101093.33, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link Inc HMO", "methodology": "case rate", "standard_charge_dollar": 125052.15 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 71743.65, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 582993.12 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 68482.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 68482.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 97832.25, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 67178.15, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "case rate", "standard_charge_dollar": 67178.15, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 68482.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 81526.88, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 67178.15, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "CIRRHOSIS AND ALCOHOLIC HEPATITIS WITH MCC", "code_information": [ { "code": "432", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 38131.0, "minimum": 8334.9, "maximum": 105521.11, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 45757.8, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 38131.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 40038.08, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 36224.93, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 38131.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 38131.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 47664.38, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 53384.1, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 61773.03, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 38131.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 38131.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "case rate", "standard_charge_dollar": 38512.82, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "case rate", "standard_charge_dollar": 59103.83, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 32588.34 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 38131.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link Inc HMO", "methodology": "case rate", "standard_charge_dollar": 22634.3 }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 27442.82 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 38131.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 41944.65, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 38131.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 105521.11 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 38131.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 40038.08, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 40038.08, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 57197.25, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 39275.45, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "case rate", "standard_charge_dollar": 39275.45, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 40038.08, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 38131.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 38131.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 47664.38, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 38131.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 38131.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 38131.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 32588.34 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 39275.45, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "CESAREAN SECTION WITH STERILIZATION WITH CC", "code_information": [ { "code": "784", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 65221.0, "minimum": 5890.0, "maximum": 105658.83, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 78265.8, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 68482.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 61960.43, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 81526.88, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 91310.1, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 105658.83, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "case rate", "standard_charge_dollar": 65873.72, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "case rate", "standard_charge_dollar": 101093.33, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link Inc HMO", "methodology": "case rate", "standard_charge_dollar": 12191.15 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 71743.65, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 56835.14 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 68482.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 68482.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 97832.25, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 67178.15, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "case rate", "standard_charge_dollar": 67178.15, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 68482.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 81526.88, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 67178.15, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "CESAREAN SECTION WITHOUT STERILIZATION WITH CC", "code_information": [ { "code": "787", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 65221.0, "minimum": 6249.0, "maximum": 105658.83, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 78265.8, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 68482.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 61960.43, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 81526.88, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 91310.1, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 105658.83, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "case rate", "standard_charge_dollar": 65873.72, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "case rate", "standard_charge_dollar": 101093.33, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link Inc HMO", "methodology": "case rate", "standard_charge_dollar": 12843.2 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 71743.65, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 59875.0 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 68482.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 68482.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 97832.25, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 67178.15, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "case rate", "standard_charge_dollar": 67178.15, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 68482.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 81526.88, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 67178.15, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "CORONARY BYPASS WITH PTCA WITH MCC", "code_information": [ { "code": "231", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 65221.0, "minimum": 20520.0, "maximum": 451952.23, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 78265.8, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 68482.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 61960.43, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 81526.88, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 91310.1, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 105658.83, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "case rate", "standard_charge_dollar": 65873.72, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "case rate", "standard_charge_dollar": 101093.33, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link Inc HMO", "methodology": "case rate", "standard_charge_dollar": 96943.85 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 71743.65, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 451952.23 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 68482.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 68482.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 97832.25, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 67178.15, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "case rate", "standard_charge_dollar": 67178.15, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 68482.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 81526.88, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 67178.15, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "CONNECTIVE TISSUE DISORDERS WITH CC", "code_information": [ { "code": "546", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 33000.0, "minimum": 5783.4, "maximum": 61837.23, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 39600.96, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 34650.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 31350.76, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 41251.0, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 46201.12, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 53461.3, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "case rate", "standard_charge_dollar": 33330.81, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "case rate", "standard_charge_dollar": 51151.24, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 29247.37 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link Inc HMO", "methodology": "case rate", "standard_charge_dollar": 13264.1 }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 24629.36 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 36300.88, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 61837.23 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 34650.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 34650.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 49501.2, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 33990.82, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "case rate", "standard_charge_dollar": 33990.82, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 34650.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 41251.0, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 29247.37 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 33990.82, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "CONNECTIVE TISSUE DISORDERS WITHOUT CCMCC", "code_information": [ { "code": "547", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 31729.0, "minimum": 4082.4, "maximum": 51402.276, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 38075.76, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 31729.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 33316.29, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 30143.31, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 31729.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 31729.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 39662.25, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 44421.72, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 51402.28, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 31729.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 31729.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "case rate", "standard_charge_dollar": 32047.1, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "case rate", "standard_charge_dollar": 49181.19, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 15063.51 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 31729.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link Inc HMO", "methodology": "case rate", "standard_charge_dollar": 9616.3 }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 12685.06 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 31729.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 34902.78, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 31729.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 44831.19 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 31729.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 33316.29, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 33316.29, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 47594.7, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 32681.69, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "case rate", "standard_charge_dollar": 32681.69, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 33316.29, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 31729.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 31729.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 39662.25, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 31729.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 31729.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 31729.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 15063.51 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 32681.69, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS OR WITH HIGH DOSE CHEMOTHERAPY AGENT WITH MCC", "code_information": [ { "code": "837", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 35212.0, "minimum": 17690.4, "maximum": 257572.94, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 42254.76, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 36972.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 33451.69, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 44015.38, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 49297.22, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 57043.93, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "case rate", "standard_charge_dollar": 35564.42, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "case rate", "standard_charge_dollar": 54579.07, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link Inc HMO", "methodology": "case rate", "standard_charge_dollar": 55249.45 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 38733.53, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 257572.94 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 36972.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 36972.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 52818.45, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 36268.67, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "case rate", "standard_charge_dollar": 36268.67, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 36972.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 44015.38, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 36268.67, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITH CC", "code_information": [ { "code": "026", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 65221.0, "minimum": 5103.0, "maximum": 166693.54, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 91310.1, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 105658.83, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "case rate", "standard_charge_dollar": 65873.72, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "case rate", "standard_charge_dollar": 101093.33, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 71214.69 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link Inc HMO", "methodology": "case rate", "standard_charge_dollar": 35755.8 }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 59970.26 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 71743.65, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 166693.54 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 68482.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 68482.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 97832.25, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 67178.15, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "case rate", "standard_charge_dollar": 67178.15, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 68482.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 81526.88, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 71214.69 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 67178.15, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 78265.8, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 68482.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 61960.43, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 81526.88, "additional_payer_notes": "125.00% of Medicare Rates" } ] } ] }, { "description": "CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH CC OR HIGH DOSE CHEMOTHERAPY AGENT", "code_information": [ { "code": "838", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 24697.0, "minimum": 8845.2, "maximum": 111911.78, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 29637.24, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 25932.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 23462.82, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 30872.13, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 34576.78, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 40010.27, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "case rate", "standard_charge_dollar": 24944.68, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "case rate", "standard_charge_dollar": 38281.44, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link Inc HMO", "methodology": "case rate", "standard_charge_dollar": 24005.1 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 27167.47, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 111911.78 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 25932.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 25932.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 37046.55, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 25438.63, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "case rate", "standard_charge_dollar": 25438.63, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 25932.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 30872.13, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 25438.63, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "CRANIOTOMY FOR MULTIPLE SIGNIFICANT TRAUMA", "code_information": [ { "code": "955", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 64968.0, "minimum": 14968.8, "maximum": 360874.46, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 77961.96, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 64968.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 68216.72, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 61719.89, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 64968.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 64968.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 81210.38, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 90955.62, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 105248.65, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 64968.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 64968.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "case rate", "standard_charge_dollar": 65617.98, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "case rate", "standard_charge_dollar": 100700.87, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 120099.54 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 64968.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link Inc HMO", "methodology": "case rate", "standard_charge_dollar": 77407.65 }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 101136.46 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 64968.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 71465.13, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 64968.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 360874.46 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 64968.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 68216.72, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 68216.72, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 97452.45, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 66917.35, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "case rate", "standard_charge_dollar": 66917.35, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 68216.72, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 64968.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 64968.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 81210.38, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 64968.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 64968.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 64968.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 120099.54 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 66917.35, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITHOUT CCMCC", "code_information": [ { "code": "839", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 24697.0, "minimum": 6633.9, "maximum": 77411.81, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 29637.24, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 25932.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 23462.82, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 30872.13, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 34576.78, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 40010.27, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "case rate", "standard_charge_dollar": 24944.68, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "case rate", "standard_charge_dollar": 38281.44, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link Inc HMO", "methodology": "case rate", "standard_charge_dollar": 16604.85 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 27167.47, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 77411.81 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 25932.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 25932.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 37046.55, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 25438.63, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "case rate", "standard_charge_dollar": 25438.63, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 25932.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 30872.13, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 25438.63, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "COMPLICATIONS OF TREATMENT WITH CC", "code_information": [ { "code": "920", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 35506.0, "minimum": 4932.9, "maximum": 57521.016, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 42608.16, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 35506.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 37282.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 33731.46, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 35506.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 35506.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 44383.5, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 49709.52, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 57521.02, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 35506.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 35506.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "case rate", "standard_charge_dollar": 35861.87, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "case rate", "standard_charge_dollar": 55035.54, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 18737.26 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 35506.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link Inc HMO", "methodology": "case rate", "standard_charge_dollar": 11526.45 }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 15778.74 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 35506.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 39057.48, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 35506.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 53736.31 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 35506.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 37282.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 37282.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 53260.2, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 36572.0, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "case rate", "standard_charge_dollar": 36572.0, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 37282.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 35506.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 35506.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 44383.5, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 35506.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 35506.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 35506.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 18737.26 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 36572.0, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "CORONARY BYPASS WITH CARDIAC CATHETERIZATION OR OPEN ABLATION WITH MCC", "code_information": [ { "code": "233", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 65221.0, "minimum": 21470.0, "maximum": 409882.11, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 78265.8, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 68482.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 61960.43, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 81526.88, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 91310.1, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 105658.83, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "case rate", "standard_charge_dollar": 65873.72, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "case rate", "standard_charge_dollar": 101093.33, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 140454.65 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link Inc HMO", "methodology": "case rate", "standard_charge_dollar": 87919.8 }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 118277.6 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 71743.65, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 409882.11 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 68482.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 68482.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 97832.25, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 67178.15, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "case rate", "standard_charge_dollar": 67178.15, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 68482.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 81526.88, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 140454.65 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 67178.15, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH CC", "code_information": [ { "code": "847", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 24697.0, "minimum": 6633.9, "maximum": 70136.53, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 29637.24, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 25932.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 23462.82, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 30872.13, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 34576.78, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 40010.27, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "case rate", "standard_charge_dollar": 24944.68, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "case rate", "standard_charge_dollar": 38281.44, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link Inc HMO", "methodology": "case rate", "standard_charge_dollar": 15044.3 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 27167.47, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 70136.53 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 25932.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 25932.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 37046.55, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 25438.63, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "case rate", "standard_charge_dollar": 25438.63, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 25932.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 30872.13, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 25438.63, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "COMPLICATIONS OF TREATMENT WITH MCC", "code_information": [ { "code": "919", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 55409.0, "minimum": 7484.4, "maximum": 98154.68, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 66491.52, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 55409.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 58180.08, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 52639.12, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 55409.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 55409.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 69262.0, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 77573.44, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 89763.55, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 55409.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 55409.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "case rate", "standard_charge_dollar": 55963.7, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "case rate", "standard_charge_dollar": 85884.88, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 34836.75 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 55409.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link Inc HMO", "methodology": "case rate", "standard_charge_dollar": 21054.2 }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 29336.21 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 55409.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 60950.56, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 55409.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 98154.68 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 55409.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 58180.08, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 58180.08, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 83114.4, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 57071.89, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "case rate", "standard_charge_dollar": 57071.89, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 58180.08, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 55409.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 55409.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 69262.0, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 55409.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 55409.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 55409.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 34836.75 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 57071.89, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "CORONARY BYPASS WITH PTCA WITHOUT MCC", "code_information": [ { "code": "232", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 65221.0, "minimum": 14440.0, "maximum": 325034.17, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 78265.8, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 68482.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 61960.43, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 81526.88, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 91310.1, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 105658.83, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "case rate", "standard_charge_dollar": 65873.72, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "case rate", "standard_charge_dollar": 101093.33, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link Inc HMO", "methodology": "case rate", "standard_charge_dollar": 69719.9 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 71743.65, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 325034.17 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 68482.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 68482.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 97832.25, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 67178.15, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "case rate", "standard_charge_dollar": 67178.15, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 68482.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 81526.88, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 67178.15, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "CONCUSSION WITHOUT CCMCC", "code_information": [ { "code": "090", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 24697.0, "minimum": 3402.0, "maximum": 44134.22, "payers_information": [ { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 10405.27 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 27167.47, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 44134.22 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 25932.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 25932.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 37046.55, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 25438.63, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "case rate", "standard_charge_dollar": 25438.63, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 25932.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 30872.13, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 12356.26 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 25438.63, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 29637.24, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 25932.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 23462.82, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 30872.13, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 34576.78, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 40010.27, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "case rate", "standard_charge_dollar": 24944.68, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "case rate", "standard_charge_dollar": 38281.44, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 12356.26 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link Inc HMO", "methodology": "case rate", "standard_charge_dollar": 9466.8 } ] } ] }, { "description": "CRANIAL AND PERIPHERAL NERVE DISORDERS WITHOUT MCC", "code_information": [ { "code": "074", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 24697.0, "minimum": 4762.8, "maximum": 55264.28, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 29637.24, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 25932.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 23462.82, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 30872.13, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 34576.78, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 40010.27, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "case rate", "standard_charge_dollar": 24944.68, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "case rate", "standard_charge_dollar": 38281.44, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 14611.68 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link Inc HMO", "methodology": "case rate", "standard_charge_dollar": 11854.2 }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 12304.58 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 27167.47, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 55264.28 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 25932.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 25932.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 37046.55, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 25438.63, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "case rate", "standard_charge_dollar": 25438.63, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 25932.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 30872.13, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 14611.68 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 25438.63, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "CRANIOTOMY WITH MAJOR DEVICE IMPLANT OR ACUTE COMPLEX CNS PRINCIPAL DIAGNOSIS WITH MCC OR CHEMOTHERAPY IMPLANT OR EPILEPSY WITH NEUROSTIMULATOR", "code_information": [ { "code": "023", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 65221.0, "minimum": 12417.3, "maximum": 307218.57, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 78265.8, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 68482.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 61960.43, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 81526.88, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 91310.1, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 105658.83, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "case rate", "standard_charge_dollar": 65873.72, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "case rate", "standard_charge_dollar": 101093.33, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 124205.42 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link Inc HMO", "methodology": "case rate", "standard_charge_dollar": 65898.45 }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 104594.04 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 71743.65, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 307218.57 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 68482.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 68482.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 97832.25, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 67178.15, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "case rate", "standard_charge_dollar": 67178.15, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 68482.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 81526.88, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 124205.42 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 67178.15, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "Dbrdmt musc&/fsca 1st 20/<", "code_information": [ { "code": "11043", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 11608.0, "discounted_cash": 788.0, "minimum": 157.24, "maximum": 9286.4, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 945.74, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1020.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 788.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 827.53, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 331.05 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 748.71, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 331.05 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 788.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 788.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 1063.96, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 1103.37, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1276.75, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 788.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 788.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "fee schedule", "standard_charge_dollar": 788.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 1221.59, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 331.05 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 788.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 906.34, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Medicare", "methodology": "fee schedule", "standard_charge_dollar": 788.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 331.05 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 788.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 866.93, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 788.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 1500.0 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 788.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 827.53, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 347.6 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 827.53, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1182.18, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 347.6 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 811.76, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 811.76, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 827.53, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Commercial", "methodology": "fee schedule", "standard_charge_dollar": 157.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 788.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 157.24 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 788.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 788.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 330.89 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 331.05 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 788.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 788.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 985.15, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 788.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 788.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 788.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 811.76, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "CHOLECYSTECTOMY WITH C.D.E. WITH CC", "code_information": [ { "code": "412", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 35212.0, "minimum": 7484.4, "maximum": 112721.33, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 42254.76, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 36972.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 33451.69, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 44015.38, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 49297.22, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 57043.93, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "case rate", "standard_charge_dollar": 35564.42, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "case rate", "standard_charge_dollar": 54579.07, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 47953.49 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link Inc HMO", "methodology": "case rate", "standard_charge_dollar": 24178.75 }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 40381.89 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 38733.53, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 112721.33 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 36972.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 36972.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 52818.45, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 36268.67, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "case rate", "standard_charge_dollar": 36268.67, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 36972.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 44015.38, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 47953.49 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 36268.67, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "DEGENERATIVE NERVOUS SYSTEM DISORDERS WITHOUT MCC", "code_information": [ { "code": "057", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 32918.0, "minimum": 6463.8, "maximum": 69461.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 39501.84, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 32918.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 34564.11, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 31272.29, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 32918.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 32918.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 41147.75, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 46085.48, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 53327.48, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 32918.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 32918.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "case rate", "standard_charge_dollar": 33247.38, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "case rate", "standard_charge_dollar": 51023.21, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 17963.1 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 32918.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link Inc HMO", "methodology": "case rate", "standard_charge_dollar": 14899.4 }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 15126.82 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 32918.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 36210.02, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 32918.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 69461.0 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 32918.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 34564.11, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 34564.11, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 49377.3, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 33905.75, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "case rate", "standard_charge_dollar": 33905.75, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 34564.11, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 32918.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 32918.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 41147.75, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 32918.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 32918.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 32918.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 17963.1 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 33905.75, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "Cor hlx vlgs double osteot", "code_information": [ { "code": "28299", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 19125.0, "discounted_cash": 7737.0, "minimum": 615.58, "maximum": 15300.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 9285.35, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1637.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7737.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 8124.68, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4725.55 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 7350.9, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4725.55 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 7737.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 7737.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 10446.02, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 10832.91, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12535.22, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7737.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7737.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "fee schedule", "standard_charge_dollar": 7737.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 11993.57, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4725.55 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7737.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8898.46, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7737.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4725.55 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7737.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 8511.57, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7737.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 5000.0 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7737.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 8124.68, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4961.83 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8124.68, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11606.69, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4961.83 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7969.92, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 7969.92, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8124.68, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Commercial", "methodology": "fee schedule", "standard_charge_dollar": 615.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7737.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 615.58 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7737.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 7737.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 4723.18 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4725.55 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7737.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7737.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9672.24, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7737.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 7737.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7737.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7969.92, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "DENTAL AND ORAL DISEASES WITHOUT CCMCC", "code_information": [ { "code": "159", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 35212.0, "minimum": 3402.0, "maximum": 57043.926, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 42254.76, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 36972.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 33451.69, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 44015.38, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 49297.22, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 57043.93, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "case rate", "standard_charge_dollar": 35564.42, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "case rate", "standard_charge_dollar": 54579.07, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 10890.52 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link Inc HMO", "methodology": "case rate", "standard_charge_dollar": 8147.75 }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 9170.97 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 38733.53, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 37984.81 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 36972.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 36972.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 52818.45, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 36268.67, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "case rate", "standard_charge_dollar": 36268.67, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 36972.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 44015.38, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 10890.52 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 36268.67, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "DEEP VEIN THROMBOPHLEBITIS WITHOUT CCMCC", "code_information": [ { "code": "295", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 24697.0, "minimum": 4082.4, "maximum": 40010.274, "payers_information": [ { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "case rate", "standard_charge_dollar": 25438.63, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 25932.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 30872.13, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 10168.31 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 25438.63, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 29637.24, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 25932.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 23462.82, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 30872.13, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 34576.78, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 40010.27, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "case rate", "standard_charge_dollar": 24944.68, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "case rate", "standard_charge_dollar": 38281.44, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 10168.31 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 8562.78 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 27167.47, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 25932.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 25932.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 37046.55, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 25438.63, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH MCC", "code_information": [ { "code": "190", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 33765.0, "minimum": 5783.4, "maximum": 59387.12, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 40518.6, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 33765.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 35453.78, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 32077.23, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 33765.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 33765.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 42206.88, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 47271.7, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 54700.11, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 33765.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 33765.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "case rate", "standard_charge_dollar": 34103.16, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "case rate", "standard_charge_dollar": 52336.53, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 25815.79 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 33765.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link Inc HMO", "methodology": "case rate", "standard_charge_dollar": 12738.55 }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 21739.62 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 33765.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 37142.05, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 33765.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 59387.12 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 33765.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 35453.78, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 35453.78, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 50648.25, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 34778.47, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "case rate", "standard_charge_dollar": 34778.47, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 35453.78, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 33765.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 33765.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 42206.88, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 33765.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 33765.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 33765.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 25815.79 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 34778.47, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "CORONARY BYPASS WITH CARDIAC CATHETERIZATION OR OPEN ABLATION WITHOUT MCC", "code_information": [ { "code": "234", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 65221.0, "minimum": 15390.0, "maximum": 292871.74, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 78265.8, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 68482.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 61960.43, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 81526.88, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 91310.1, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 105658.83, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "case rate", "standard_charge_dollar": 65873.72, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "case rate", "standard_charge_dollar": 101093.33, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 91046.09 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link Inc HMO", "methodology": "case rate", "standard_charge_dollar": 62821.05 }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 76670.39 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 71743.65, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 292871.74 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 68482.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 68482.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 97832.25, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 67178.15, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "case rate", "standard_charge_dollar": 67178.15, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 68482.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 81526.88, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 91046.09 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 67178.15, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITHOUT CCMCC", "code_information": [ { "code": "192", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 33765.0, "minimum": 3572.1, "maximum": 54700.11, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 40518.6, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 33765.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 35453.78, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 32077.23, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 33765.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 33765.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 42206.88, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 47271.7, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 54700.11, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 33765.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 33765.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "case rate", "standard_charge_dollar": 34103.16, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "case rate", "standard_charge_dollar": 52336.53, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 14718.2 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 33765.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link Inc HMO", "methodology": "case rate", "standard_charge_dollar": 7383.0 }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 12394.27 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 33765.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 37142.05, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 33765.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 34419.55 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 33765.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 35453.78, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 35453.78, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 50648.25, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 34778.47, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "case rate", "standard_charge_dollar": 34778.47, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 35453.78, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 33765.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 33765.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 42206.88, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 33765.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 33765.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 33765.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 14718.2 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 34778.47, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "CORONARY BYPASS WITHOUT CARDIAC CATHETERIZATION WITHOUT MCC", "code_information": [ { "code": "236", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 65221.0, "minimum": 11020.0, "maximum": 224574.13, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 78265.8, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 68482.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 61960.43, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 81526.88, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 91310.1, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 105658.83, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "case rate", "standard_charge_dollar": 65873.72, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "case rate", "standard_charge_dollar": 101093.33, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 69756.89 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link Inc HMO", "methodology": "case rate", "standard_charge_dollar": 48171.2 }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 58742.64 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 71743.65, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 224574.13 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 68482.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 68482.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 97832.25, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 67178.15, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "case rate", "standard_charge_dollar": 67178.15, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 68482.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 81526.88, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 69756.89 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 67178.15, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "CIRCULATORY DISORDERS EXCEPT AMI, WITH CARDIAC CATHETERIZATION WITH MCC", "code_information": [ { "code": "286", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 35212.0, "minimum": 10260.0, "maximum": 118634.85, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 42254.76, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 36972.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 33451.69, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 44015.38, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 49297.22, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 57043.93, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "case rate", "standard_charge_dollar": 35564.42, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "case rate", "standard_charge_dollar": 54579.07, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 50672.33 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link Inc HMO", "methodology": "case rate", "standard_charge_dollar": 25447.2 }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 42671.43 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 38733.53, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 118634.85 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 36972.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 36972.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 52818.45, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 36268.67, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "case rate", "standard_charge_dollar": 36268.67, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 36972.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 44015.38, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 50672.33 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 36268.67, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "DEPRESSIVE NEUROSES", "code_information": [ { "code": "881", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 2968.0, "maximum": 50444.47, "payers_information": [ { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 8517.12 }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link Inc HMO", "methodology": "case rate", "standard_charge_dollar": 10820.35 }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 7172.31 }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 50444.47 }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 8517.12 } ] } ] }, { "description": "CIRRHOSIS AND ALCOHOLIC HEPATITIS WITH CC", "code_information": [ { "code": "433", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 33000.0, "minimum": 5613.3, "maximum": 56626.05, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 39600.96, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 34650.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 31350.76, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 41251.0, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 46201.12, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 53461.3, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "case rate", "standard_charge_dollar": 33330.81, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "case rate", "standard_charge_dollar": 51151.24, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 21778.03 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link Inc HMO", "methodology": "case rate", "standard_charge_dollar": 12146.3 }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 18339.39 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 36300.88, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 56626.05 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 34650.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 34650.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 49501.2, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 33990.82, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "case rate", "standard_charge_dollar": 33990.82, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 34650.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 41251.0, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 21778.03 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 33990.82, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "Correction of astigmatism", "code_information": [ { "code": "65772", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2724.0, "discounted_cash": 1063.0, "minimum": 370.36, "maximum": 2724.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 1275.65, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1437.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1063.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 1116.19, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 493.47 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 1009.89, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 493.47 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 1063.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 1063.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 1435.1, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 1488.26, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1722.12, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1063.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 2724.0 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1063.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "fee schedule", "standard_charge_dollar": 1063.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 1647.71, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 493.47 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1063.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1222.5, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1063.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 493.47 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1063.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 1169.34, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1063.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1063.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 1116.19, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 518.14 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1116.19, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1594.56, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 518.14 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1094.93, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 1094.93, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1116.19, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Commercial", "methodology": "fee schedule", "standard_charge_dollar": 370.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1063.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 370.36 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1063.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1063.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 493.22 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 493.47 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1063.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1063.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1328.8, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1063.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 1063.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1063.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1094.93, "additional_payer_notes": "103.00% of Medicare Rates" } ] }, { "setting": "outpatient", "gross_charge": 2724.0, "discounted_cash": 1063.0, "minimum": 370.36, "maximum": 2724.0, "payers_information": [ { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 1063.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1063.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1094.93, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 1275.65, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1437.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1063.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 1116.19, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 493.47 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 1009.89, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 493.47 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 1063.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 1063.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 1435.1, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 1488.26, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1722.12, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1063.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 2724.0 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1063.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "fee schedule", "standard_charge_dollar": 1063.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 1647.71, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 493.47 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1063.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1222.5, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1063.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 493.47 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1063.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 1169.34, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1063.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1063.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 1116.19, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 518.14 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1116.19, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1594.56, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 518.14 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1094.93, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 1094.93, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1116.19, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Commercial", "methodology": "fee schedule", "standard_charge_dollar": 370.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1063.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 370.36 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1063.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1063.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 493.22 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 493.47 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1063.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1063.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1328.8, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1063.04, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "CRANIAL AND PERIPHERAL NERVE DISORDERS WITH MCC", "code_information": [ { "code": "073", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 65221.0, "minimum": 6633.9, "maximum": 105658.83, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 78265.8, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 68482.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 61960.43, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 81526.88, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 91310.1, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 105658.83, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "case rate", "standard_charge_dollar": 65873.72, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "case rate", "standard_charge_dollar": 101093.33, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 40297.27 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link Inc HMO", "methodology": "case rate", "standard_charge_dollar": 18449.45 }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 33934.54 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 71743.65, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 86011.34 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 68482.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 68482.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 97832.25, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 67178.15, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "case rate", "standard_charge_dollar": 67178.15, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 68482.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 81526.88, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 40297.27 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 67178.15, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITH MCC", "code_information": [ { "code": "025", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 65221.0, "minimum": 11056.5, "maximum": 243762.23, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 78265.8, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 68482.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 61960.43, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 81526.88, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 91310.1, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 105658.83, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "case rate", "standard_charge_dollar": 65873.72, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "case rate", "standard_charge_dollar": 101093.33, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 125792.75 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link Inc HMO", "methodology": "case rate", "standard_charge_dollar": 52287.05 }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 105930.74 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 71743.65, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 243762.23 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 68482.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 68482.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 97832.25, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 67178.15, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "case rate", "standard_charge_dollar": 67178.15, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 68482.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 81526.88, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 125792.75 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 67178.15, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "COMPLICATED PEPTIC ULCER WITHOUT CCMCC", "code_information": [ { "code": "382", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 33000.0, "minimum": 4082.4, "maximum": 53461.296, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 39600.96, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 34650.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 31350.76, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 41251.0, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 46201.12, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 53461.3, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "case rate", "standard_charge_dollar": 33330.81, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "case rate", "standard_charge_dollar": 51151.24, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 18935.89 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link Inc HMO", "methodology": "case rate", "standard_charge_dollar": 9206.9 }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 15946.02 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 36300.88, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 42922.57 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 34650.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 34650.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 49501.2, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 33990.82, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "case rate", "standard_charge_dollar": 33990.82, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 34650.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 41251.0, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 18935.89 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 33990.82, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "DIABETES WITH CC", "code_information": [ { "code": "638", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 36359.0, "minimum": 5103.0, "maximum": 58902.066, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 43631.16, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 36359.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 38177.27, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 34541.34, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 36359.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 36359.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 45449.13, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 50903.02, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 58902.07, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 36359.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 36359.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "case rate", "standard_charge_dollar": 36722.89, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "case rate", "standard_charge_dollar": 56356.92, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 15865.91 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 36359.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link Inc HMO", "methodology": "case rate", "standard_charge_dollar": 10306.3 }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 13360.77 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 36359.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 39995.23, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 36359.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 48047.97 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 36359.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 38177.27, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 38177.27, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 54538.95, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 37450.08, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "case rate", "standard_charge_dollar": 37450.08, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 38177.27, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 36359.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 36359.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 45449.13, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 36359.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 36359.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 36359.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 15865.91 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 37450.08, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "CONCUSSION WITH MCC", "code_information": [ { "code": "088", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 43009.0, "minimum": 6123.6, "maximum": 72474.05, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 51610.92, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 43009.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 45159.56, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 40858.65, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 43009.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 43009.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 53761.38, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 60212.74, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 69674.74, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 43009.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 43009.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "case rate", "standard_charge_dollar": 43439.19, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "case rate", "standard_charge_dollar": 66664.11, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 48719.14 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 43009.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link Inc HMO", "methodology": "case rate", "standard_charge_dollar": 15545.7 }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 41026.64 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 43009.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 47310.01, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 43009.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 72474.05 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 43009.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 45159.56, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 45159.56, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 64513.65, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 44299.37, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "case rate", "standard_charge_dollar": 44299.37, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 45159.56, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 43009.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 43009.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 53761.38, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 43009.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 43009.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 43009.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 48719.14 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 44299.37, "additional_payer_notes": "103.00% 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", "discounted_cash": 65221.0, "minimum": 6633.9, "maximum": 209728.69, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 78265.8, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 68482.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 61960.43, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 81526.88, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 91310.1, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 105658.83, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "case rate", "standard_charge_dollar": 65873.72, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "case rate", "standard_charge_dollar": 101093.33, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 85859.27 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link Inc HMO", "methodology": "case rate", "standard_charge_dollar": 44986.85 }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 72302.54 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 71743.65, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 209728.69 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 68482.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 68482.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 97832.25, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 67178.15, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "case rate", "standard_charge_dollar": 67178.15, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 68482.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 81526.88, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 85859.27 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 67178.15, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "DIABETES WITHOUT CCMCC", "code_information": [ { "code": "639", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 33000.0, "minimum": 3402.0, "maximum": 53461.296, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 39600.96, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 34650.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 31350.76, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 41251.0, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 46201.12, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 53461.3, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "case rate", "standard_charge_dollar": 33330.81, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "case rate", "standard_charge_dollar": 51151.24, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 10617.07 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link Inc HMO", "methodology": "case rate", "standard_charge_dollar": 7143.8 }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 8940.69 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 36300.88, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 33304.4 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 34650.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 34650.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 49501.2, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 33990.82, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "case rate", "standard_charge_dollar": 33990.82, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 34650.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 41251.0, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 10617.07 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 33990.82, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "D&C, CONIZATION, LAPAROSCOPY AND TUBAL INTERRUPTION WITH CCMCC", "code_information": [ { "code": "744", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 65221.0, "minimum": 7654.5, "maximum": 109858.4, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 78265.8, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 68482.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 61960.43, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 81526.88, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 91310.1, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 105658.83, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "case rate", "standard_charge_dollar": 65873.72, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "case rate", "standard_charge_dollar": 101093.33, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 21907.13 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link Inc HMO", "methodology": "case rate", "standard_charge_dollar": 23564.65 }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 18448.11 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 71743.65, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 109858.4 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 68482.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 68482.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 97832.25, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 67178.15, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "case rate", "standard_charge_dollar": 67178.15, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 68482.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 81526.88, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 21907.13 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 67178.15, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "CONNECTIVE TISSUE DISORDERS WITH MCC", "code_information": [ { "code": "545", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 48801.0, "minimum": 9865.8, "maximum": 133051.38, "payers_information": [ { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 61001.38, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 48801.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 48801.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 48801.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 69409.11 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 50265.13, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 58561.32, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 48801.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 51241.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 46361.05, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 48801.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 48801.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 61001.38, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 68321.54, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 79057.78, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 48801.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 48801.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "case rate", "standard_charge_dollar": 49289.11, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "case rate", "standard_charge_dollar": 75641.71, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 69409.11 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 48801.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link Inc HMO", "methodology": "case rate", "standard_charge_dollar": 28539.55 }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 58449.78 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 48801.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 53681.21, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 48801.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 133051.38 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 48801.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 51241.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 51241.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 73201.65, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 50265.13, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "case rate", "standard_charge_dollar": 50265.13, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 51241.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 48801.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 48801.1, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH CC", "code_information": [ { "code": "439", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 35212.0, "minimum": 5103.0, "maximum": 57043.926, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 42254.76, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 36972.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 33451.69, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 44015.38, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 49297.22, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 57043.93, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "case rate", "standard_charge_dollar": 35564.42, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "case rate", "standard_charge_dollar": 54579.07, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 24371.27 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link Inc HMO", "methodology": "case rate", "standard_charge_dollar": 9673.8 }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 20523.18 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 38733.53, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 45099.26 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 36972.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 36972.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 52818.45, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 36268.67, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "case rate", "standard_charge_dollar": 36268.67, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 36972.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 44015.38, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 24371.27 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 36268.67, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "Decompression of tibia nerve", "code_information": [ { "code": "28035", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5334.0, "discounted_cash": 2082.0, "minimum": 374.19, "maximum": 4755.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 2498.78, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1437.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2082.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 2186.44, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2712.76 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 1978.2, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2712.76 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 2082.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 2082.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 2811.13, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 2915.25, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3373.36, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2082.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2082.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "fee schedule", "standard_charge_dollar": 2082.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 3227.6, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2712.76 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2082.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2394.67, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2082.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2712.76 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2082.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 2290.55, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2082.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 4755.0 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2082.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 2186.44, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2848.4 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2186.44, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3123.48, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2848.4 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2144.79, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 2144.79, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2186.44, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Commercial", "methodology": "fee schedule", "standard_charge_dollar": 374.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2082.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 374.19 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2082.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 2082.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 2711.4 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2712.76 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2082.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2082.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2602.9, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2082.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 2082.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2082.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2144.79, "additional_payer_notes": "103.00% of Medicare Rates" } ] }, { "setting": "outpatient", "gross_charge": 5334.0, "discounted_cash": 2082.0, "minimum": 374.19, "maximum": 4755.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 2498.78, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1437.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2082.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 2186.44, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2712.76 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 1978.2, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2712.76 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 2082.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 2082.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 2811.13, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 2915.25, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3373.36, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2082.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2082.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "fee schedule", "standard_charge_dollar": 2082.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 3227.6, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2712.76 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2082.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2394.67, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2082.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2712.76 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2082.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 2290.55, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2082.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 4755.0 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2082.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 2186.44, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2848.4 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2186.44, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3123.48, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2848.4 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2144.79, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 2144.79, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2186.44, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Commercial", "methodology": "fee schedule", "standard_charge_dollar": 374.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2082.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 374.19 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2082.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 2082.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 2711.4 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2712.76 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2082.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2082.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2602.9, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2082.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 2082.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2082.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2144.79, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "Corneal transplant", "code_information": [ { "code": "65730", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 28169.0, "discounted_cash": 4407.0, "minimum": 1129.38, "maximum": 22535.2, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 5289.3, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2261.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4407.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 4628.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2754.11 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 4187.36, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2754.11 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 4407.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 4407.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 5950.46, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 6170.85, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7140.56, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4407.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4407.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "fee schedule", "standard_charge_dollar": 4407.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 6832.01, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2754.11 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4407.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5068.91, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4407.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2754.11 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4407.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 4848.53, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4407.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4407.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 4628.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2891.82 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4628.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6611.63, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2891.82 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4539.98, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 4539.98, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4628.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1129.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4407.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1129.38 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4407.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 4407.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 2752.73 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2754.11 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4407.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4407.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5509.69, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4407.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 4407.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4407.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4539.98, "additional_payer_notes": "103.00% of Medicare Rates" } ] }, { "setting": "outpatient", "gross_charge": 28169.0, "discounted_cash": 4407.0, "minimum": 1129.38, "maximum": 22535.2, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 5289.3, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 2261.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4407.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 4628.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2754.11 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 4187.36, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2754.11 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 4407.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 4407.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 5950.46, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 6170.85, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7140.56, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4407.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4407.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "fee schedule", "standard_charge_dollar": 4407.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 6832.01, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2754.11 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4407.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5068.91, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4407.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2754.11 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4407.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 4848.53, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4407.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4407.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 4628.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2891.82 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4628.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6611.63, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2891.82 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4539.98, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 4539.98, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4628.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1129.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4407.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1129.38 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4407.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 4407.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 2752.73 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2754.11 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4407.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4407.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5509.69, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4407.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 4407.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4407.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4539.98, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "CORONARY BYPASS WITHOUT CARDIAC CATHETERIZATION WITH MCC", "code_information": [ { "code": "235", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 65221.0, "minimum": 15390.0, "maximum": 314633.25, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 78265.8, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 68482.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 61960.43, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 81526.88, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 91310.1, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 105658.83, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "case rate", "standard_charge_dollar": 65873.72, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "case rate", "standard_charge_dollar": 101093.33, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 122261.96 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link Inc HMO", "methodology": "case rate", "standard_charge_dollar": 67488.9 }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 102957.44 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 71743.65, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 314633.25 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 68482.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 68482.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 97832.25, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 67178.15, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "case rate", "standard_charge_dollar": 67178.15, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 68482.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 81526.88, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 122261.96 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 67178.15, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "DISORDERS OF THE BILIARY TRACT WITH CC", "code_information": [ { "code": "445", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 35889.0, "minimum": 5103.0, "maximum": 58674.07, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 43066.92, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 35889.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 37683.56, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 34094.65, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 35889.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 35889.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 44861.38, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 50244.74, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 58140.34, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 35889.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 35889.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "case rate", "standard_charge_dollar": 36247.99, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "case rate", "standard_charge_dollar": 55628.11, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 20699.73 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 35889.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link Inc HMO", "methodology": "case rate", "standard_charge_dollar": 12585.6 }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 17431.35 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 35889.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 39478.01, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 35889.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 58674.07 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 35889.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 37683.56, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 37683.56, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 53833.65, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 36965.77, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "case rate", "standard_charge_dollar": 36965.77, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 37683.56, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 35889.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 35889.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 44861.38, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 35889.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 35889.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 35889.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 20699.73 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 36965.77, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "CORONARY INTRAVASCULAR LITHOTRIPSY WITH INTRALUMINAL DEVICE WITH MCC", "code_information": [ { "code": "323", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 33000.0, "minimum": 7824.6, "maximum": 232004.9, "payers_information": [ { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 232004.9 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 34650.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 34650.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 49501.2, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 33990.82, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "case rate", "standard_charge_dollar": 33990.82, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 34650.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 41251.0, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 33990.82, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 39600.96, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 34650.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 31350.76, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 41251.0, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 46201.12, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 53461.3, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "case rate", "standard_charge_dollar": 33330.81, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "case rate", "standard_charge_dollar": 51151.24, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link Inc HMO", "methodology": "case rate", "standard_charge_dollar": 49765.1 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 36300.88, "additional_payer_notes": "110.00% of Medicare Rates" } ] } ] }, { "description": "DEGENERATIVE NERVOUS SYSTEM DISORDERS WITH MCC", "code_information": [ { "code": "056", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 46920.0, "minimum": 10206.0, "maximum": 124548.36, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 56304.48, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 46920.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 49266.42, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 44574.38, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 46920.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 46920.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 58650.5, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 65688.56, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 76011.05, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 46920.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 46920.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "case rate", "standard_charge_dollar": 47389.6, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "case rate", "standard_charge_dollar": 72726.62, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 48672.94 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 46920.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link Inc HMO", "methodology": "case rate", "standard_charge_dollar": 26715.65 }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 40987.74 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 46920.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 51612.44, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 46920.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 124548.36 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 46920.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 49266.42, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 49266.42, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 70380.6, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 48328.01, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "case rate", "standard_charge_dollar": 48328.01, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 49266.42, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 46920.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 46920.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 58650.5, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 46920.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 46920.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 46920.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 48672.94 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 48328.01, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "CORONARY INTRAVASCULAR LITHOTRIPSY WITH INTRALUMINAL DEVICE WITHOUT MCC", "code_information": [ { "code": "324", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 24697.0, "minimum": 3912.3, "maximum": 168934.56, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 29637.24, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 25932.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 23462.82, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 30872.13, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 34576.78, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 40010.27, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "case rate", "standard_charge_dollar": 24944.68, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "case rate", "standard_charge_dollar": 38281.44, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link Inc HMO", "methodology": "case rate", "standard_charge_dollar": 36236.5 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 27167.47, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 168934.56 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 25932.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 25932.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 37046.55, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 25438.63, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "case rate", "standard_charge_dollar": 25438.63, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 25932.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 30872.13, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 25438.63, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "CORONARY INTRAVASCULAR LITHOTRIPSY WITHOUT INTRALUMINAL DEVICE", "code_information": [ { "code": "325", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 33000.0, "minimum": 4592.7, "maximum": 172119.18, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 39600.96, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 34650.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 31350.76, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 41251.0, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 46201.12, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 53461.3, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "case rate", "standard_charge_dollar": 33330.81, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "case rate", "standard_charge_dollar": 51151.24, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link Inc HMO", "methodology": "case rate", "standard_charge_dollar": 36919.6 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 36300.88, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 172119.18 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 34650.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 34650.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 49501.2, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 33990.82, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "case rate", "standard_charge_dollar": 33990.82, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 34650.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 41251.0, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 33990.82, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "EAR, NOSE, MOUTH AND THROAT MALIGNANCY WITH CC", "code_information": [ { "code": "147", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 33000.0, "minimum": 5953.5, "maximum": 68168.93, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 39600.96, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 34650.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 31350.76, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 41251.0, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 46201.12, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 53461.3, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "case rate", "standard_charge_dollar": 33330.81, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "case rate", "standard_charge_dollar": 51151.24, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 23681.12 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link Inc HMO", "methodology": "case rate", "standard_charge_dollar": 14622.25 }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 19941.99 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 36300.88, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 68168.93 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 34650.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 34650.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 49501.2, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 33990.82, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "case rate", "standard_charge_dollar": 33990.82, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 34650.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 41251.0, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 23681.12 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 33990.82, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "EAR, NOSE, MOUTH AND THROAT MALIGNANCY WITH MCC", "code_information": [ { "code": "146", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 33000.0, "minimum": 10035.9, "maximum": 113520.17, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 39600.96, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 34650.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 31350.76, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 41251.0, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 46201.12, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 53461.3, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "case rate", "standard_charge_dollar": 33330.81, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "case rate", "standard_charge_dollar": 51151.24, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 37512.29 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link Inc HMO", "methodology": "case rate", "standard_charge_dollar": 24350.1 }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 31589.3 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 36300.88, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 113520.17 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 34650.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 34650.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 49501.2, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 33990.82, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "case rate", "standard_charge_dollar": 33990.82, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 34650.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 41251.0, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 37512.29 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 33990.82, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "027", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 65221.0, "minimum": 2721.6, "maximum": 135260.24, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 78265.8, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 68482.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 61960.43, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 81526.88, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 91310.1, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 105658.83, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "case rate", "standard_charge_dollar": 65873.72, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "case rate", "standard_charge_dollar": 101093.33, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 46662.48 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link Inc HMO", "methodology": "case rate", "standard_charge_dollar": 29013.35 }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 39294.72 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 71743.65, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 135260.24 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 68482.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 68482.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 97832.25, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 67178.15, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "case rate", "standard_charge_dollar": 67178.15, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 68482.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 81526.88, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 46662.48 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 67178.15, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH MCC", "code_information": [ { "code": "438", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 54133.0, "minimum": 8164.8, "maximum": 87696.108, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 64960.08, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 54133.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 56840.07, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 51426.73, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 54133.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 54133.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 67666.75, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 75786.76, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 87696.11, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 54133.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 54133.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "case rate", "standard_charge_dollar": 54674.73, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "case rate", "standard_charge_dollar": 83906.77, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 52027.1 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 54133.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link Inc HMO", "methodology": "case rate", "standard_charge_dollar": 18747.3 }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 43812.3 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 54133.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 59546.74, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 54133.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 87399.91 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 54133.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 56840.07, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 56840.07, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 81200.1, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 55757.4, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "case rate", "standard_charge_dollar": 55757.4, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 56840.07, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 54133.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 54133.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 67666.75, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 54133.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 54133.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 54133.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 52027.1 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 55757.4, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ECMO OR TRACHEOSTOMY WITH MV >96 HOURS OR PRINCIPAL DIAGNOSIS EXCEPT FACE, MOUTH AND NECK WITH MAJOR O.R. PROCEDURES", "code_information": [ { "code": "003", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 180469.0, "minimum": 40994.1, "maximum": 1137946.65, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 216562.8, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 180469.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 189492.45, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 171445.55, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 180469.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 180469.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 225586.25, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 252656.6, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 292359.78, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 180469.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 180469.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "case rate", "standard_charge_dollar": 182273.69, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "case rate", "standard_charge_dollar": 279726.95, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 384358.03 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 180469.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link Inc HMO", "methodology": "case rate", "standard_charge_dollar": 244089.8 }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 323669.92 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 180469.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 198515.9, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 180469.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 1137946.65 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 180469.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 189492.45, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 189492.45, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 270703.5, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 185883.07, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "case rate", "standard_charge_dollar": 185883.07, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 189492.45, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 180469.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 180469.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 225586.25, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 180469.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 180469.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 180469.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 384358.03 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 185883.07, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "DIABETES WITH MCC", "code_information": [ { "code": "637", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 45685.0, "minimum": 6804.0, "maximum": 77025.8, "payers_information": [ { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 45685.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 77025.8 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 45685.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 47969.78, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 47969.78, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 68528.25, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 47056.07, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "case rate", "standard_charge_dollar": 47056.07, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 47969.78, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 45685.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 45685.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 57106.88, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 45685.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 45685.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 45685.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 29250.85 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 47056.07, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 54822.6, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 45685.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 47969.78, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 43401.23, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 45685.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 45685.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 57106.88, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 63959.7, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 74010.51, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 45685.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 45685.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "case rate", "standard_charge_dollar": 46142.36, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "case rate", "standard_charge_dollar": 70812.53, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 29250.85 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 45685.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link Inc HMO", "methodology": "case rate", "standard_charge_dollar": 16522.05 }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 24632.3 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 45685.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 50254.05, "additional_payer_notes": "110.00% of Medicare Rates" } ] } ] }, { "description": "DISORDERS OF THE BILIARY TRACT WITH MCC", "code_information": [ { "code": "444", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 39294.0, "minimum": 7654.5, "maximum": 89581.96, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 47152.92, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 39294.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 41258.81, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 37329.4, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 39294.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 39294.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 49117.63, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 55011.74, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 63656.44, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 39294.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 39294.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "case rate", "standard_charge_dollar": 39687.04, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "case rate", "standard_charge_dollar": 60905.86, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 30886.8 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 39294.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link Inc HMO", "methodology": "case rate", "standard_charge_dollar": 19215.35 }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 26009.94 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 39294.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 43223.51, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 39294.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 89581.96 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 39294.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 41258.81, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 41258.81, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 58941.15, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 40472.92, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "case rate", "standard_charge_dollar": 40472.92, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 41258.81, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 39294.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 39294.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 49117.63, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 39294.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 39294.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 39294.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 30886.8 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 40472.92, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "D&C, CONIZATION, LAPAROSCOPY AND TUBAL INTERRUPTION WITHOUT CCMCC", "code_information": [ { "code": "745", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 65221.0, "minimum": 3610.0, "maximum": 105658.83, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 78265.8, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 68482.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 61960.43, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 81526.88, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 91310.1, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 105658.83, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "case rate", "standard_charge_dollar": 65873.72, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "case rate", "standard_charge_dollar": 101093.33, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 17301.66 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link Inc HMO", "methodology": "case rate", "standard_charge_dollar": 13081.25 }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 14569.82 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 71743.65, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 60984.79 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 68482.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 68482.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 97832.25, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 67178.15, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "case rate", "standard_charge_dollar": 67178.15, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 68482.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 81526.88, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 17301.66 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 67178.15, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ENDOCRINE DISORDERS WITH MCC", "code_information": [ { "code": "643", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 65221.0, "minimum": 8505.0, "maximum": 105658.83, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 78265.8, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 68482.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 61960.43, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 81526.88, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 91310.1, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 105658.83, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "case rate", "standard_charge_dollar": 65873.72, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "case rate", "standard_charge_dollar": 101093.33, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 51814.76 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link Inc HMO", "methodology": "case rate", "standard_charge_dollar": 18930.15 }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 43633.48 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 71743.65, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 88252.36 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 68482.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 68482.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 97832.25, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 67178.15, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "case rate", "standard_charge_dollar": 67178.15, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 68482.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 81526.88, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 51814.76 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 67178.15, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "DIGESTIVE MALIGNANCY WITHOUT CCMCC", "code_information": [ { "code": "376", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 33000.0, "minimum": 3912.3, "maximum": 53461.296, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 39600.96, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 34650.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 31350.76, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 41251.0, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 46201.12, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 53461.3, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "case rate", "standard_charge_dollar": 33330.81, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "case rate", "standard_charge_dollar": 51151.24, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 18920.25 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link Inc HMO", "methodology": "case rate", "standard_charge_dollar": 10629.45 }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 15932.84 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 36300.88, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 49554.5 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 34650.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 34650.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 49501.2, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 33990.82, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "case rate", "standard_charge_dollar": 33990.82, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 34650.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 41251.0, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 18920.25 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 33990.82, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "DEEP VEIN THROMBOPHLEBITIS WITH CCMCC", "code_information": [ { "code": "294", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 39175.0, "minimum": 5783.4, "maximum": 63463.986, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 47010.36, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 39175.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 41134.07, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 37216.54, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 39175.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 39175.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 48969.13, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 54845.42, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 63463.99, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 39175.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 39175.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "case rate", "standard_charge_dollar": 39567.05, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "case rate", "standard_charge_dollar": 60721.72, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 23461.86 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 39175.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 19757.35 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 39175.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 43092.83, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 39175.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 39175.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 41134.07, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 41134.07, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 58762.95, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 40350.56, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "case rate", "standard_charge_dollar": 40350.56, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 41134.07, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 39175.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 39175.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 48969.13, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 39175.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 39175.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 39175.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 23461.86 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 40350.56, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "DISORDERS OF LIVER EXCEPT MALIGNANCY, CIRRHOSIS OR ALCOHOLIC HEPATITIS WITH CC", "code_information": [ { "code": "442", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 24697.0, "minimum": 5443.2, "maximum": 51752.63, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 29637.24, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 25932.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 23462.82, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 30872.13, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 34576.78, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 40010.27, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "case rate", "standard_charge_dollar": 24944.68, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "case rate", "standard_charge_dollar": 38281.44, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 20917.62 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link Inc HMO", "methodology": "case rate", "standard_charge_dollar": 11100.95 }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 17614.84 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 27167.47, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 51752.63 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 25932.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 25932.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 37046.55, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 25438.63, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "case rate", "standard_charge_dollar": 25438.63, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 25932.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 30872.13, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 20917.62 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 25438.63, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "DISORDERS OF LIVER EXCEPT MALIGNANCY, CIRRHOSIS OR ALCOHOLIC HEPATITIS WITH MCC", "code_information": [ { "code": "441", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 48108.0, "minimum": 8164.8, "maximum": 96219.25, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 57730.56, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 48108.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 50514.24, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 45703.36, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 48108.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 48108.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 60136.0, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 67352.32, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 77936.26, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 48108.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 48108.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "case rate", "standard_charge_dollar": 48589.89, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "case rate", "standard_charge_dollar": 74568.64, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 43684.08 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 48108.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link Inc HMO", "methodology": "case rate", "standard_charge_dollar": 20639.05 }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 36786.59 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 48108.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 52919.68, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 48108.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 96219.25 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 48108.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 50514.24, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 50514.24, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 72163.2, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 49552.06, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "case rate", "standard_charge_dollar": 49552.06, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 50514.24, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 48108.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 48108.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 60136.0, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 48108.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 48108.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 48108.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 43684.08 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 49552.06, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "DISORDERS OF LIVER EXCEPT MALIGNANCY, CIRRHOSIS OR ALCOHOLIC HEPATITIS WITHOUT CCMCC", "code_information": [ { "code": "443", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 24697.0, "minimum": 4082.4, "maximum": 40010.274, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 29637.24, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 25932.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 23462.82, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 30872.13, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 34576.78, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 40010.27, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "case rate", "standard_charge_dollar": 24944.68, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "case rate", "standard_charge_dollar": 38281.44, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 14426.39 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link Inc HMO", "methodology": "case rate", "standard_charge_dollar": 8046.55 }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 12148.54 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 27167.47, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 37513.02 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 25932.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 25932.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 37046.55, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 25438.63, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "case rate", "standard_charge_dollar": 25438.63, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 25932.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 30872.13, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 14426.39 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 25438.63, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "DENTAL AND ORAL DISEASES WITH CC", "code_information": [ { "code": "158", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 35212.0, "minimum": 4762.8, "maximum": 57043.926, "payers_information": [ { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 48777.11 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 36972.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 36972.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 52818.45, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 36268.67, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "case rate", "standard_charge_dollar": 36268.67, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 36972.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 44015.38, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 13428.6 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 36268.67, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 42254.76, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 36972.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 33451.69, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 44015.38, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 49297.22, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 57043.93, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "case rate", "standard_charge_dollar": 35564.42, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "case rate", "standard_charge_dollar": 54579.07, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 13428.6 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link Inc HMO", "methodology": "case rate", "standard_charge_dollar": 10462.7 }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 11308.3 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 38733.53, "additional_payer_notes": "110.00% of Medicare Rates" } ] } ] }, { "description": "DENTAL AND ORAL DISEASES WITH MCC", "code_information": [ { "code": "157", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 48801.0, "minimum": 7484.4, "maximum": 92042.8, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 58561.32, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 48801.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 51241.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 46361.05, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 48801.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 48801.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 61001.38, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 68321.54, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 79057.78, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 48801.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 48801.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "case rate", "standard_charge_dollar": 49289.11, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "case rate", "standard_charge_dollar": 75641.71, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 28860.85 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 48801.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link Inc HMO", "methodology": "case rate", "standard_charge_dollar": 19743.2 }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 24303.87 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 48801.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 53681.21, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 48801.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 92042.8 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 48801.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 51241.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 51241.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 73201.65, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 50265.13, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "case rate", "standard_charge_dollar": 50265.13, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 51241.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 48801.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 48801.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 61001.38, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 48801.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 48801.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 48801.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 28860.85 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 50265.13, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "Exc face-mm b9+marg 2.1-3 cm", "code_information": [ { "code": "11443", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6988.0, "discounted_cash": 1761.0, "minimum": 173.2, "maximum": 5590.4, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 2113.45, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 762.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 1849.27, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1048.77 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 1673.15, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1048.77 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 2377.63, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 2465.69, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2853.16, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 2729.88, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1048.77 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2025.39, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1048.77 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 1937.33, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 1849.27, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1101.21 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1849.27, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2641.82, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1101.21 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1814.05, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 1814.05, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1849.27, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Commercial", "methodology": "fee schedule", "standard_charge_dollar": 173.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 173.2 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 1048.25 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1048.77 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2201.51, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1814.05, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITHOUT CCMCC", "code_information": [ { "code": "440", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 33000.0, "minimum": 3912.3, "maximum": 53461.296, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 39600.96, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 34650.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 31350.76, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 41251.0, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 46201.12, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 53461.3, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "case rate", "standard_charge_dollar": 33330.81, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "case rate", "standard_charge_dollar": 51151.24, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 14930.16 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link Inc HMO", "methodology": "case rate", "standard_charge_dollar": 7146.1 }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 12572.77 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 36300.88, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 33315.12 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 34650.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 34650.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 49501.2, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 33990.82, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "case rate", "standard_charge_dollar": 33990.82, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 34650.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 41251.0, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 14930.16 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 33990.82, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "Exchange lens prosthesis", "code_information": [ { "code": "66986", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6988.0, "discounted_cash": 2460.0, "minimum": 809.76, "maximum": 5590.4, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 2953.18, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1897.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2460.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 2584.03, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1480.09 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 2337.93, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1480.09 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 2460.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 2460.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 3322.32, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 3445.37, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3986.79, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2460.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2460.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "fee schedule", "standard_charge_dollar": 2460.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 3814.52, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1480.09 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2460.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2830.13, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2460.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1480.09 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2460.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 2707.08, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2460.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2460.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 2584.03, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1554.09 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2584.03, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3691.47, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1554.09 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2534.81, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 2534.81, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2584.03, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Commercial", "methodology": "fee schedule", "standard_charge_dollar": 809.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2460.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 809.76 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2460.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 2460.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 1479.35 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1480.09 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2460.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2460.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3076.23, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2460.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 2460.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2460.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2534.81, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "DISORDERS OF PERSONALITY AND IMPULSE CONTROL", "code_information": [ { "code": "883", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 4303.6, "maximum": 105419.24, "payers_information": [ { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 12331.38 }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link Inc HMO", "methodology": "case rate", "standard_charge_dollar": 22612.45 }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 10384.32 }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 105419.24 }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 12331.38 } ] } ] }, { "description": "EXTENSIVE BURNS OR FULL THICKNESS BURNS WITH MV >96 HOURS WITH SKIN GRAFT", "code_information": [ { "code": "927", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 48801.0, "minimum": 40824.0, "maximum": 1144664.36, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 58561.32, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 48801.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 51241.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 46361.05, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 48801.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 48801.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 61001.38, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 68321.54, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 79057.78, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 48801.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 48801.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "case rate", "standard_charge_dollar": 49289.11, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "case rate", "standard_charge_dollar": 75641.71, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 228227.72 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 48801.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link Inc HMO", "methodology": "case rate", "standard_charge_dollar": 245530.75 }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 192191.77 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 48801.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 53681.21, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 48801.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 1144664.36 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 48801.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 51241.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 51241.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 73201.65, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 50265.13, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "case rate", "standard_charge_dollar": 50265.13, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 51241.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 48801.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 48801.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 61001.38, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 48801.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 48801.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 48801.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 228227.72 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 50265.13, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ENDOCRINE DISORDERS WITH CC", "code_information": [ { "code": "644", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 33000.0, "minimum": 5783.4, "maximum": 54953.33, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 39600.96, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 34650.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 31350.76, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 41251.0, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 46201.12, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 53461.3, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "case rate", "standard_charge_dollar": 33330.81, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "case rate", "standard_charge_dollar": 51151.24, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 18482.22 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link Inc HMO", "methodology": "case rate", "standard_charge_dollar": 11787.5 }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 15563.98 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 36300.88, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 54953.33 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 34650.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 34650.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 49501.2, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 33990.82, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "case rate", "standard_charge_dollar": 33990.82, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 34650.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 41251.0, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 18482.22 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 33990.82, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ENDOCRINE DISORDERS WITHOUT CCMCC", "code_information": [ { "code": "645", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 33000.0, "minimum": 4422.6, "maximum": 53461.296, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 39600.96, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 34650.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 31350.76, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 41251.0, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 46201.12, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 53461.3, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "case rate", "standard_charge_dollar": 33330.81, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "case rate", "standard_charge_dollar": 51151.24, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 10419.6 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link Inc HMO", "methodology": "case rate", "standard_charge_dollar": 8835.45 }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 8774.4 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 36300.88, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 41190.87 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 34650.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 34650.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 49501.2, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 33990.82, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "case rate", "standard_charge_dollar": 33990.82, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 34650.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 41251.0, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 10419.6 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 33990.82, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "EXTRACRANIAL PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "039", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 65221.0, "minimum": 2041.2, "maximum": 105658.83, "payers_information": [ { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 67178.15, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "case rate", "standard_charge_dollar": 67178.15, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 68482.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 81526.88, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 25363.09 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 67178.15, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 78265.8, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 68482.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 61960.43, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 81526.88, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 91310.1, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 105658.83, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "case rate", "standard_charge_dollar": 65873.72, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "case rate", "standard_charge_dollar": 101093.33, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 25363.09 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link Inc HMO", "methodology": "case rate", "standard_charge_dollar": 13518.25 }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 21358.39 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 71743.65, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 63022.08 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 68482.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 68482.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 97832.25, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "DIGESTIVE MALIGNANCY WITH CC", "code_information": [ { "code": "375", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 33000.0, "minimum": 6123.6, "maximum": 64850.28, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 39600.96, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 34650.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 31350.76, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 41251.0, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 46201.12, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 53461.3, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "case rate", "standard_charge_dollar": 33330.81, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "case rate", "standard_charge_dollar": 51151.24, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 26310.35 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link Inc HMO", "methodology": "case rate", "standard_charge_dollar": 13910.4 }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 22156.08 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 36300.88, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 64850.28 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 34650.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 34650.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 49501.2, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 33990.82, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "case rate", "standard_charge_dollar": 33990.82, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 34650.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 41251.0, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 26310.35 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 33990.82, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ESOPHAGITIS, GASTROENTERITIS AND MISCELLANEOUS DIGESTIVE DISORDERS WITHOUT MCC", "code_information": [ { "code": "392", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 32365.0, "minimum": 4252.5, "maximum": 52431.786, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 38838.36, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 32365.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 33983.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 30747.04, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 32365.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 32365.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 40456.63, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 45311.42, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 52431.79, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 32365.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 32365.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "case rate", "standard_charge_dollar": 32688.95, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "case rate", "standard_charge_dollar": 50166.22, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 12623.84 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 32365.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link Inc HMO", "methodology": "case rate", "standard_charge_dollar": 8965.4 }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 10630.6 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 32365.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 35601.83, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 32365.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 41796.69 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 32365.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 33983.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 33983.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 48547.95, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 33336.26, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "case rate", "standard_charge_dollar": 33336.26, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 33983.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 32365.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 32365.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 40456.63, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 32365.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 32365.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 32365.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 12623.84 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 33336.26, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "DIGESTIVE MALIGNANCY WITH MCC", "code_information": [ { "code": "374", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 48801.0, "minimum": 9525.6, "maximum": 114662.12, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 58561.32, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 48801.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 51241.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 46361.05, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 48801.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 48801.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 61001.38, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 68321.54, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 79057.78, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 48801.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 48801.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "case rate", "standard_charge_dollar": 49289.11, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "case rate", "standard_charge_dollar": 75641.71, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 47504.46 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 48801.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link Inc HMO", "methodology": "case rate", "standard_charge_dollar": 24595.05 }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 40003.75 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 48801.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 53681.21, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 48801.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 114662.12 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 48801.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 51241.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 51241.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 73201.65, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 50265.13, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "case rate", "standard_charge_dollar": 50265.13, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 51241.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 48801.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 48801.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 61001.38, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 48801.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 48801.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 48801.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 47504.46 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 50265.13, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ENDOVASCULAR CARDIAC VALVE REPLACEMENT AND SUPPLEMENT PROCEDURES WITH MCC", "code_information": [ { "code": "266", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 65221.0, "minimum": 4422.6, "maximum": 328561.91, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 78265.8, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 68482.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 61960.43, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 81526.88, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 91310.1, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 105658.83, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "case rate", "standard_charge_dollar": 65873.72, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "case rate", "standard_charge_dollar": 101093.33, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link Inc HMO", "methodology": "case rate", "standard_charge_dollar": 70476.6 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 71743.65, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 328561.91 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 68482.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 68482.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 97832.25, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 67178.15, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "case rate", "standard_charge_dollar": 67178.15, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 68482.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 81526.88, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 67178.15, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "Exc face les sbq 2 cm/>", "code_information": [ { "code": "21012", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 11608.0, "discounted_cash": 1761.0, "minimum": 365.11, "maximum": 9286.4, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 2113.45, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 762.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 1849.27, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1551.83 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 1673.15, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1551.83 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 2377.63, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 2465.69, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2853.16, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 2729.88, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1551.83 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2025.39, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1551.83 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 1937.33, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 1849.27, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1629.42 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1849.27, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2641.82, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1629.42 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1814.05, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 1814.05, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1849.27, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Commercial", "methodology": "fee schedule", "standard_charge_dollar": 365.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 365.11 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1551.83 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2201.51, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1814.05, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "Exc hip pelvis les sc 3 cm/>", "code_information": [ { "code": "27043", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10068.0, "discounted_cash": 3097.0, "minimum": 527.73, "maximum": 8054.4, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 3716.99, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1163.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3252.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1551.83 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 2942.62, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1551.83 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 4181.61, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 4336.49, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5017.93, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 4801.11, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1551.83 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3562.11, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1551.83 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 3407.24, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3252.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1629.42 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3252.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4646.24, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1629.42 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3190.41, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 3190.41, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3252.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Commercial", "methodology": "fee schedule", "standard_charge_dollar": 527.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 527.73 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1551.83 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3871.86, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3097.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3190.41, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "DISORDERS OF THE BILIARY TRACT WITHOUT CCMCC", "code_information": [ { "code": "446", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 33000.0, "minimum": 3742.2, "maximum": 53461.296, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 39600.96, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 34650.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 31350.76, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 41251.0, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 46201.12, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 53461.3, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "case rate", "standard_charge_dollar": 33330.81, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "case rate", "standard_charge_dollar": 51151.24, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 14467.81 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link Inc HMO", "methodology": "case rate", "standard_charge_dollar": 9513.95 }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 12183.42 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 36300.88, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 44354.03 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 34650.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 34650.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 49501.2, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 33990.82, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "case rate", "standard_charge_dollar": 33990.82, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 34650.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 41251.0, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 14467.81 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 33990.82, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH CC", "code_information": [ { "code": "982", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 65495.0, "minimum": 6974.1, "maximum": 131807.56, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 78594.36, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 65495.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 68770.07, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 62220.54, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 65495.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 65495.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 81869.13, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 91693.42, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 106102.39, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 65495.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 65495.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "case rate", "standard_charge_dollar": 66150.25, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "case rate", "standard_charge_dollar": 101517.72, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 63519.8 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 65495.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link Inc HMO", "methodology": "case rate", "standard_charge_dollar": 28272.75 }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. 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"additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 68770.07, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 68770.07, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 98242.95, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 67460.16, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "case rate", "standard_charge_dollar": 67460.16, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 68770.07, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 65495.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 65495.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 81869.13, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 65495.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 65495.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 65495.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 63519.8 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 67460.16, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "DYSEQUILIBRIUM", "code_information": [ { "code": "149", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 24697.0, "minimum": 3231.9, "maximum": 40295.53, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 29637.24, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 25932.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 23462.82, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 30872.13, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 34576.78, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 40010.27, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "case rate", "standard_charge_dollar": 24944.68, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "case rate", "standard_charge_dollar": 38281.44, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 12113.66 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link Inc HMO", "methodology": "case rate", "standard_charge_dollar": 8643.4 }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 10200.98 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 27167.47, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 40295.53 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 25932.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 25932.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 37046.55, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 25438.63, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "case rate", "standard_charge_dollar": 25438.63, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 25932.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 30872.13, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 12113.66 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 25438.63, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH MCC", "code_information": [ { "code": "981", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 120920.0, "minimum": 14798.7, "maximum": 251541.47, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 145104.0, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 120920.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 126966.0, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 114874.0, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 120920.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 120920.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 151150.0, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 169288.0, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 195890.4, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 120920.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 120920.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "case rate", "standard_charge_dollar": 122129.2, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "case rate", "standard_charge_dollar": 187426.0, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 134978.35 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 120920.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link Inc HMO", "methodology": "case rate", "standard_charge_dollar": 53955.7 }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 113665.98 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 120920.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 133012.0, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 120920.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 251541.47 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 120920.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 126966.0, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 126966.0, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 181380.0, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 124547.6, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "case rate", "standard_charge_dollar": 124547.6, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 126966.0, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 120920.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 120920.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 151150.0, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 120920.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 120920.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 120920.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 134978.35 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 124547.6, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "EAR, NOSE, MOUTH AND THROAT MALIGNANCY WITHOUT CCMCC", "code_information": [ { "code": "148", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 33000.0, "minimum": 3572.1, "maximum": 53461.296, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 39600.96, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 34650.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 31350.76, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 41251.0, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 46201.12, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 53461.3, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "case rate", "standard_charge_dollar": 33330.81, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "case rate", "standard_charge_dollar": 51151.24, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 19504.65 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link Inc HMO", "methodology": "case rate", "standard_charge_dollar": 9166.65 }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 16424.97 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 36300.88, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 42734.92 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 34650.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 34650.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 49501.2, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 33990.82, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "case rate", "standard_charge_dollar": 33990.82, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 34650.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 41251.0, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 19504.65 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 33990.82, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "FOOT PROCEDURES WITH CC", "code_information": [ { "code": "504", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 33000.0, "minimum": 6804.0, "maximum": 100213.42, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 39600.96, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 34650.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 31350.76, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 41251.0, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 46201.12, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 53461.3, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "case rate", "standard_charge_dollar": 33330.81, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "case rate", "standard_charge_dollar": 51151.24, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 27975.83 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link Inc HMO", "methodology": "case rate", "standard_charge_dollar": 21495.8 }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 23558.59 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 36300.88, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 100213.42 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 34650.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 34650.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 49501.2, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 33990.82, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "case rate", "standard_charge_dollar": 33990.82, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 34650.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 41251.0, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 27975.83 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 33990.82, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "FRACTURES OF HIP AND PELVIS WITHOUT MCC", "code_information": [ { "code": "536", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 24697.0, "minimum": 4762.8, "maximum": 43297.86, "payers_information": [ { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 25932.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 25932.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 37046.55, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 25438.63, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "case rate", "standard_charge_dollar": 25438.63, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 25932.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 30872.13, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 12922.0 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 25438.63, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 29637.24, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 25932.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 23462.82, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 30872.13, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 34576.78, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 40010.27, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "case rate", "standard_charge_dollar": 24944.68, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "case rate", "standard_charge_dollar": 38281.44, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 12922.0 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link Inc HMO", "methodology": "case rate", "standard_charge_dollar": 9287.4 }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 10881.69 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 27167.47, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 43297.86 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "EXTRACRANIAL PROCEDURES WITH CC", "code_information": [ { "code": "038", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 65221.0, "minimum": 3231.9, "maximum": 105658.83, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 78265.8, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 68482.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 61960.43, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 81526.88, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 91310.1, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 105658.83, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "case rate", "standard_charge_dollar": 65873.72, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "case rate", "standard_charge_dollar": 101093.33, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 37617.23 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link Inc HMO", "methodology": "case rate", "standard_charge_dollar": 18659.9 }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 31677.66 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 71743.65, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 86992.45 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 68482.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 68482.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 97832.25, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 67178.15, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "case rate", "standard_charge_dollar": 67178.15, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 68482.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 81526.88, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 37617.23 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 67178.15, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "FEVER AND INFLAMMATORY CONDITIONS", "code_information": [ { "code": "864", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 35212.0, "minimum": 4592.7, "maximum": 57043.926, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 42254.76, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 36972.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 33451.69, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 44015.38, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 49297.22, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 57043.93, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "case rate", "standard_charge_dollar": 35564.42, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "case rate", "standard_charge_dollar": 54579.07, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link Inc HMO", "methodology": "case rate", "standard_charge_dollar": 10208.55 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 38733.53, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 47592.26 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 36972.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 36972.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 52818.45, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 36268.67, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "case rate", "standard_charge_dollar": 36268.67, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 36972.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 44015.38, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 36268.67, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ENDOVASCULAR CARDIAC VALVE REPLACEMENT AND SUPPLEMENT PROCEDURES WITHOUT MCC", "code_information": [ { "code": "267", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 65221.0, "minimum": 2211.3, "maximum": 255240.77, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 78265.8, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 68482.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 61960.43, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 81526.88, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 91310.1, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 105658.83, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "case rate", "standard_charge_dollar": 65873.72, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "case rate", "standard_charge_dollar": 101093.33, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link Inc HMO", "methodology": "case rate", "standard_charge_dollar": 54749.2 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 71743.65, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 255240.77 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 68482.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 68482.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 97832.25, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 67178.15, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "case rate", "standard_charge_dollar": 67178.15, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 68482.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 81526.88, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 67178.15, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "FULL TERM NEONATE WITH MAJOR PROBLEMS", "code_information": [ { "code": "793", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 48067.0, "minimum": 5245.0, "maximum": 223544.76, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 57680.88, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 48067.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 50470.77, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 45664.03, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 48067.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 48067.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 60084.25, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 67294.36, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 77869.19, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 48067.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 48067.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "case rate", "standard_charge_dollar": 48548.07, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "case rate", "standard_charge_dollar": 74504.47, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 14579.42 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 48067.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link Inc HMO", "methodology": "case rate", "standard_charge_dollar": 47950.4 }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 12277.41 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 48067.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 52874.14, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 48067.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 223544.76 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 48067.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 50470.77, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 50470.77, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 72101.1, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 49509.42, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "case rate", "standard_charge_dollar": 49509.42, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 50470.77, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 48067.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 48067.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 60084.25, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 48067.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 48067.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 48067.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 14579.42 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 49509.42, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "EXTRAOCULAR PROCEDURES EXCEPT ORBIT", "code_information": [ { "code": "115", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 48801.0, "minimum": 6293.7, "maximum": 82290.59, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 58561.32, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 48801.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 51241.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 46361.05, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 48801.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 48801.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 61001.38, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 68321.54, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 79057.78, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 48801.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 48801.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "case rate", "standard_charge_dollar": 49289.11, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "case rate", "standard_charge_dollar": 75641.71, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 21102.5 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 48801.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link Inc HMO", "methodology": "case rate", "standard_charge_dollar": 17651.35 }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 17770.53 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 48801.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 53681.21, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 48801.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 82290.59 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 48801.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 51241.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 51241.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 73201.65, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 50265.13, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "case rate", "standard_charge_dollar": 50265.13, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 51241.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 48801.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 48801.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 61001.38, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 48801.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 48801.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 48801.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 21102.5 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 50265.13, "additional_payer_notes": "103.00% 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", "discounted_cash": 48801.0, "minimum": 10035.9, "maximum": 172676.75, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 58561.32, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 48801.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 51241.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 46361.05, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 48801.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 48801.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 61001.38, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 68321.54, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 79057.78, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 48801.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 48801.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "case rate", "standard_charge_dollar": 49289.11, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "case rate", "standard_charge_dollar": 75641.71, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 37578.11 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 48801.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link Inc HMO", "methodology": "case rate", "standard_charge_dollar": 37039.2 }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 31644.73 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 48801.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 53681.21, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 48801.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 172676.75 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 48801.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 51241.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 51241.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 73201.65, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 50265.13, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "case rate", "standard_charge_dollar": 50265.13, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 51241.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 48801.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 48801.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 61001.38, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 48801.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 48801.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 48801.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 37578.11 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 50265.13, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "EXTREME IMMATURITY OR RESPIRATORY DISTRESS SYNDROME, NEONATE", "code_information": [ { "code": "790", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 48067.0, "minimum": 18882.0, "maximum": 318648.87, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 57680.88, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 48067.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 50470.77, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 45664.03, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 48067.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 48067.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 60084.25, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 67294.36, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 77869.19, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 48067.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 48067.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "case rate", "standard_charge_dollar": 48548.07, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "case rate", "standard_charge_dollar": 74504.47, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 97361.24 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 48067.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link Inc HMO", "methodology": "case rate", "standard_charge_dollar": 68350.25 }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 81988.42 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 48067.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 52874.14, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 48067.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 318648.87 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 48067.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 50470.77, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 50470.77, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 72101.1, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 49509.42, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "case rate", "standard_charge_dollar": 49509.42, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 50470.77, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 48067.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 48067.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 60084.25, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 48067.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 48067.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 48067.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 97361.24 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 49509.42, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "EPISTAXIS WITH MCC", "code_information": [ { "code": "150", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 24697.0, "minimum": 6123.6, "maximum": 71385.71, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 29637.24, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 25932.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 23462.82, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 30872.13, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 34576.78, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 40010.27, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "case rate", "standard_charge_dollar": 24944.68, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "case rate", "standard_charge_dollar": 38281.44, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link Inc HMO", "methodology": "case rate", "standard_charge_dollar": 15312.25 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 27167.47, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 71385.71 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 25932.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 25932.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 37046.55, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 25438.63, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "case rate", "standard_charge_dollar": 25438.63, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 25932.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 30872.13, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 25438.63, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "GASTROINTESTINAL OBSTRUCTION WITHOUT CCMCC", "code_information": [ { "code": "390", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 24697.0, "minimum": 3912.3, "maximum": 40010.274, "payers_information": [ { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 25932.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 30872.13, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 12256.47 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 25438.63, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 29637.24, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 25932.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 23462.82, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 30872.13, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 34576.78, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 40010.27, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "case rate", "standard_charge_dollar": 24944.68, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "case rate", "standard_charge_dollar": 38281.44, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 12256.47 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link Inc HMO", "methodology": "case rate", "standard_charge_dollar": 6256.0 }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 10321.24 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 27167.47, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 29165.47 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 25932.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 25932.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 37046.55, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 25438.63, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "case rate", "standard_charge_dollar": 25438.63, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "EPISTAXIS WITHOUT MCC", "code_information": [ { "code": "151", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 24697.0, "minimum": 3742.2, "maximum": 40010.274, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 29637.24, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 25932.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 23462.82, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 30872.13, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 34576.78, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 40010.27, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "case rate", "standard_charge_dollar": 24944.68, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "case rate", "standard_charge_dollar": 38281.44, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 13828.21 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link Inc HMO", "methodology": "case rate", "standard_charge_dollar": 8441.0 }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 11644.81 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 27167.47, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 39351.94 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 25932.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 25932.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 37046.55, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 25438.63, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "case rate", "standard_charge_dollar": 25438.63, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 25932.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 30872.13, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 13828.21 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 25438.63, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "Glaucoma surgery", "code_information": [ { "code": "66170", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5923.0, "discounted_cash": 2460.0, "minimum": 990.8, "maximum": 4738.4, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 2953.18, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1437.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2460.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 2584.03, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2883.64 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 2337.93, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2883.64 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 2460.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 2460.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 3322.32, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 3445.37, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3986.79, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2460.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2460.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "fee schedule", "standard_charge_dollar": 2460.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 3814.52, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2883.64 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2460.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2830.13, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2460.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2883.64 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2460.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 2707.08, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2460.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2460.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 2584.03, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3027.82 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2584.03, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3691.47, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3027.82 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2534.81, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 2534.81, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2584.03, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Commercial", "methodology": "fee schedule", "standard_charge_dollar": 990.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2460.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 990.8 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2460.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 2460.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 2882.19 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2883.64 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2460.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2460.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3076.23, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2460.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 2460.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2460.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2534.81, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "HAND OR WRIST PROCEDURES, EXCEPT MAJOR THUMB OR JOINT PROCEDURES WITH CCMCC", "code_information": [ { "code": "513", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 24697.0, "minimum": 6804.0, "maximum": 84402.95, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 29637.24, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 25932.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 23462.82, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 30872.13, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 34576.78, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 40010.27, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "case rate", "standard_charge_dollar": 24944.68, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "case rate", "standard_charge_dollar": 38281.44, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 21547.61 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link Inc HMO", "methodology": "case rate", "standard_charge_dollar": 18104.45 }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 18145.35 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 27167.47, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 84402.95 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 25932.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 25932.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 37046.55, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 25438.63, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "case rate", "standard_charge_dollar": 25438.63, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 25932.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 30872.13, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 21547.61 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 25438.63, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "ESOPHAGITIS, GASTROENTERITIS AND MISCELLANEOUS DIGESTIVE DISORDERS WITH MCC", "code_information": [ { "code": "391", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 40012.0, "minimum": 6463.8, "maximum": 67997.37, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 48014.76, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 40012.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 42012.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 38011.69, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 40012.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 40012.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 50015.38, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 56017.22, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 64819.93, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 40012.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 40012.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "case rate", "standard_charge_dollar": 40412.42, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "case rate", "standard_charge_dollar": 62019.07, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 21265.24 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 40012.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link Inc HMO", "methodology": "case rate", "standard_charge_dollar": 14585.45 }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 17907.57 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 40012.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 44013.53, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 40012.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 67997.37 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 40012.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 42012.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 42012.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 60018.45, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 41212.67, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "case rate", "standard_charge_dollar": 41212.67, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 42012.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 40012.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 40012.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 50015.38, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 40012.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 40012.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 40012.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 21265.24 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 41212.67, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "HAND PROCEDURES FOR INJURIES", "code_information": [ { "code": "906", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 24697.0, "minimum": 5443.2, "maximum": 105312.02, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 29637.24, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 25932.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 23462.82, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 30872.13, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 34576.78, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 40010.27, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "case rate", "standard_charge_dollar": 24944.68, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "case rate", "standard_charge_dollar": 38281.44, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 21694.68 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link Inc HMO", "methodology": "case rate", "standard_charge_dollar": 22589.45 }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 18269.21 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 27167.47, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 105312.02 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 25932.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 25932.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 37046.55, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 25438.63, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "case rate", "standard_charge_dollar": 25438.63, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 25932.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 30872.13, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 21694.68 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 25438.63, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "FRACTURE, SPRAIN, STRAIN AND DISLOCATION EXCEPT FEMUR, HIP, PELVIS AND THIGH WITH MCC", "code_information": [ { "code": "562", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 65221.0, "minimum": 6974.1, "maximum": 105658.83, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 78265.8, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 68482.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 61960.43, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 81526.88, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 91310.1, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 105658.83, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "case rate", "standard_charge_dollar": 65873.72, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "case rate", "standard_charge_dollar": 101093.33, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 27069.71 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link Inc HMO", "methodology": "case rate", "standard_charge_dollar": 16385.2 }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 22795.54 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 71743.65, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 76387.8 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 68482.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 68482.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 97832.25, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 67178.15, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "case rate", "standard_charge_dollar": 67178.15, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 68482.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 81526.88, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 27069.71 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 67178.15, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "FRACTURES OF HIP AND PELVIS WITH MCC", "code_information": [ { "code": "535", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 33000.0, "minimum": 6633.9, "maximum": 68731.87, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 39600.96, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 34650.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 31350.76, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 41251.0, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 46201.12, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 53461.3, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "case rate", "standard_charge_dollar": 33330.81, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "case rate", "standard_charge_dollar": 51151.24, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 26225.69 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link Inc HMO", "methodology": "case rate", "standard_charge_dollar": 14743.0 }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 22084.79 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 36300.88, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 68731.87 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 34650.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 34650.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 49501.2, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 33990.82, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "case rate", "standard_charge_dollar": 33990.82, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 34650.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 41251.0, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 26225.69 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 33990.82, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "EXTENSIVE BURNS OR FULL THICKNESS BURNS WITH MV >96 HOURS WITHOUT SKIN GRAFT", "code_information": [ { "code": "933", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 33000.0, "minimum": 4422.6, "maximum": 208779.74, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 39600.96, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 34650.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 31350.76, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 41251.0, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 46201.12, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 53461.3, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "case rate", "standard_charge_dollar": 33330.81, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "case rate", "standard_charge_dollar": 51151.24, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 146891.99 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link Inc HMO", "methodology": "case rate", "standard_charge_dollar": 44783.3 }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 123698.52 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 36300.88, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 208779.74 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 34650.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 34650.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 49501.2, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 33990.82, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "case rate", "standard_charge_dollar": 33990.82, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 34650.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 41251.0, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 146891.99 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 33990.82, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "FULL THICKNESS BURN WITH SKIN GRAFT OR INHALATION INJURY WITH CCMCC", "code_information": [ { "code": "928", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 48801.0, "minimum": 21262.5, "maximum": 384549.97, "payers_information": [ { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 82307.17 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 48801.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link Inc HMO", "methodology": "case rate", "standard_charge_dollar": 82486.05 }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 69311.3 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 48801.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 53681.21, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 48801.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 384549.97 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 48801.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 51241.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 51241.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 73201.65, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 50265.13, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "case rate", "standard_charge_dollar": 50265.13, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 51241.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 48801.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 48801.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 61001.38, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 48801.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 48801.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 48801.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 82307.17 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 50265.13, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 58561.32, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 48801.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 51241.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 46361.05, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 48801.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 48801.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 61001.38, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 68321.54, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 79057.78, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 48801.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 48801.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "case rate", "standard_charge_dollar": 49289.11, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "case rate", "standard_charge_dollar": 75641.71, "additional_payer_notes": "155.00% of Medicare Rates" } ] } ] }, { "description": "EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITHOUT CCMCC", "code_information": [ { "code": "983", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 35212.0, "minimum": 3402.0, "maximum": 91892.68, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 42254.76, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 36972.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 33451.69, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 44015.38, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 49297.22, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 57043.93, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "case rate", "standard_charge_dollar": 35564.42, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "case rate", "standard_charge_dollar": 54579.07, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 25666.24 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link Inc HMO", "methodology": "case rate", "standard_charge_dollar": 19711.0 }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 21613.67 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 38733.53, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 91892.68 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 36972.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 36972.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 52818.45, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 36268.67, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "case rate", "standard_charge_dollar": 36268.67, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 36972.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 44015.38, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 25666.24 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 36268.67, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "FRACTURE, SPRAIN, STRAIN AND DISLOCATION EXCEPT FEMUR, HIP, PELVIS AND THIGH WITHOUT MCC", "code_information": [ { "code": "563", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 31729.0, "minimum": 4762.8, "maximum": 51402.276, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 38075.76, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 31729.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 33316.29, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 30143.31, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 31729.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 31729.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 39662.25, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 44421.72, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 51402.28, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 31729.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 31729.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "case rate", "standard_charge_dollar": 32047.1, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "case rate", "standard_charge_dollar": 49181.19, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 11817.9 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 31729.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link Inc HMO", "methodology": "case rate", "standard_charge_dollar": 10298.25 }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 9951.91 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 31729.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 34902.78, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 31729.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 48010.44 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 31729.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 33316.29, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 33316.29, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 47594.7, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 32681.69, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "case rate", "standard_charge_dollar": 32681.69, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 33316.29, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 31729.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 31729.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 39662.25, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 31729.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 31729.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 31729.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 11817.9 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 32681.69, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "GASTROINTESTINAL HEMORRHAGE WITHOUT CCMCC", "code_information": [ { "code": "379", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 33000.0, "minimum": 3402.0, "maximum": 53461.296, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 39600.96, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 34650.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 31350.76, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 41251.0, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 46201.12, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 53461.3, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "case rate", "standard_charge_dollar": 33330.81, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "case rate", "standard_charge_dollar": 51151.24, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 14466.43 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link Inc HMO", "methodology": "case rate", "standard_charge_dollar": 7249.6 }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 12182.26 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 36300.88, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 33797.64 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 34650.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 34650.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 49501.2, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 33990.82, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "case rate", "standard_charge_dollar": 33990.82, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 34650.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 41251.0, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 14466.43 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 33990.82, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "GASTROINTESTINAL OBSTRUCTION WITH CC", "code_information": [ { "code": "389", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 35212.0, "minimum": 5103.0, "maximum": 57043.926, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 42254.76, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 36972.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 33451.69, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 44015.38, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 49297.22, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 57043.93, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "case rate", "standard_charge_dollar": 35564.42, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "case rate", "standard_charge_dollar": 54579.07, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 16973.28 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link Inc HMO", "methodology": "case rate", "standard_charge_dollar": 9082.7 }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 14293.29 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 38733.53, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 42343.55 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 36972.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 36972.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 52818.45, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 36268.67, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "case rate", "standard_charge_dollar": 36268.67, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 36972.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 44015.38, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 35212.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 16973.28 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 36268.67, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "GASTROINTESTINAL OBSTRUCTION WITH MCC", "code_information": [ { "code": "388", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 51053.0, "minimum": 7654.5, "maximum": 82707.318, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 61264.68, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 51053.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 53606.6, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 48501.21, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 51053.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 51053.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 63817.38, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 71475.46, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 82707.32, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 51053.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 51053.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "case rate", "standard_charge_dollar": 51564.44, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "case rate", "standard_charge_dollar": 79133.55, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 27996.32 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 51053.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link Inc HMO", "methodology": "case rate", "standard_charge_dollar": 16983.2 }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 23575.85 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 51053.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 56159.29, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 51053.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 79175.68 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 51053.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 53606.6, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 53606.6, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 76580.85, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 52585.52, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "case rate", "standard_charge_dollar": 52585.52, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 53606.6, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 51053.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 51053.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 63817.38, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 51053.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 51053.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 51053.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 27996.32 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 52585.52, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "EXTRACRANIAL PROCEDURES WITH MCC", "code_information": [ { "code": "037", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 65221.0, "minimum": 8334.9, "maximum": 176499.36, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 78265.8, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 68482.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 61960.43, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 81526.88, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 91310.1, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 105658.83, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "case rate", "standard_charge_dollar": 65873.72, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "case rate", "standard_charge_dollar": 101093.33, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 81058.27 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link Inc HMO", "methodology": "case rate", "standard_charge_dollar": 37859.15 }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 68259.59 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 71743.65, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 176499.36 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 68482.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 68482.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 97832.25, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 67178.15, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "case rate", "standard_charge_dollar": 67178.15, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 68482.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 81526.88, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 81058.27 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 67178.15, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "FRACTURES OF FEMUR WITH MCC", "code_information": [ { "code": "533", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 37480.0, "minimum": 7144.2, "maximum": 84049.1, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 44976.6, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 37480.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 39354.53, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 35606.48, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 37480.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 37480.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 46850.63, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 52472.7, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 60718.41, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 37480.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 37480.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "case rate", "standard_charge_dollar": 37855.31, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "case rate", "standard_charge_dollar": 58094.78, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 37480.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link Inc HMO", "methodology": "case rate", "standard_charge_dollar": 18028.55 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 37480.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 41228.55, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 37480.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 84049.1 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 37480.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 39354.53, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 39354.53, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 56220.75, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 38604.92, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "case rate", "standard_charge_dollar": 38604.92, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 39354.53, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 37480.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 37480.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 46850.63, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 37480.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 37480.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 37480.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 38604.92, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "FEMALE REPRODUCTIVE SYSTEM RECONSTRUCTIVE PROCEDURES", "code_information": [ { "code": "748", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 65221.0, "minimum": 2660.0, "maximum": 105658.83, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 78265.8, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 68482.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 61960.43, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 81526.88, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 91310.1, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 105658.83, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "case rate", "standard_charge_dollar": 65873.72, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "case rate", "standard_charge_dollar": 101093.33, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 14909.81 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link Inc HMO", "methodology": "case rate", "standard_charge_dollar": 15953.95 }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 12555.63 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 71743.65, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 74377.31 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 68482.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 68482.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 97832.25, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 67178.15, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "case rate", "standard_charge_dollar": 67178.15, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 68482.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 81526.88, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 65221.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 14909.81 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 67178.15, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "GASTROINTESTINAL HEMORRHAGE WITH MCC", "code_information": [ { "code": "377", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 36752.0, "minimum": 7654.5, "maximum": 98004.56, "payers_information": [ { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 38406.61 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 36752.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link Inc HMO", "methodology": "case rate", "standard_charge_dollar": 21022.0 }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 32342.41 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 36752.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 40427.2, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 36752.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 98004.56 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 36752.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 38589.6, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 38589.6, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 55128.0, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 37854.56, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "case rate", "standard_charge_dollar": 37854.56, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 38589.6, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 36752.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 36752.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 45940.0, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 36752.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 36752.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 36752.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 38406.61 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 37854.56, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 44102.4, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 36752.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 38589.6, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 34914.4, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 36752.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 36752.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 45940.0, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 51452.8, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 59538.24, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 36752.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 36752.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "case rate", "standard_charge_dollar": 37119.52, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "case rate", "standard_charge_dollar": 56965.6, "additional_payer_notes": "155.00% of Medicare Rates" } ] } ] }, { "description": "HAND OR WRIST PROCEDURES, EXCEPT MAJOR THUMB OR JOINT PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "514", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 24697.0, "minimum": 4082.4, "maximum": 54808.57, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 29637.24, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 25932.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 23462.82, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 30872.13, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 34576.78, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 40010.27, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "case rate", "standard_charge_dollar": 24944.68, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "case rate", "standard_charge_dollar": 38281.44, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 14845.08 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link Inc HMO", "methodology": "case rate", "standard_charge_dollar": 11756.45 }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 12501.12 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 27167.47, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 54808.57 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 25932.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 25932.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 37046.55, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 25438.63, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "case rate", "standard_charge_dollar": 25438.63, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 25932.59, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 30872.13, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 24697.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 14845.08 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 25438.63, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "FOOT PROCEDURES WITH MCC", "code_information": [ { "code": "503", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 33000.0, "minimum": 12417.3, "maximum": 149639.24, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 39600.96, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 34650.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 31350.76, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 41251.0, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 46201.12, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 53461.3, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "case rate", "standard_charge_dollar": 33330.81, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "case rate", "standard_charge_dollar": 51151.24, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 46833.97 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link Inc HMO", "methodology": "case rate", "standard_charge_dollar": 32097.65 }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 39439.14 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 36300.88, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 149639.24 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 34650.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 34650.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 49501.2, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 33990.82, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "case rate", "standard_charge_dollar": 33990.82, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 34650.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 41251.0, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 46833.97 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 33990.82, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "HC VNPNXR 3 YEARS/> PHYS/QHP SKILL", "code_information": [ { "code": "36410", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 633.0, "minimum": 8.93, "maximum": 506.4, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 65.14 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 65.14 }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 65.14 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 65.14 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 68.4 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 68.4 }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.93 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 65.14 } ] } ] }, { "description": "FOOT PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "505", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 33000.0, "minimum": 6804.0, "maximum": 96117.39, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 39600.96, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 34650.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 31350.76, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 41251.0, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 46201.12, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 53461.3, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "case rate", "standard_charge_dollar": 33330.81, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "case rate", "standard_charge_dollar": 51151.24, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 19705.05 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link Inc HMO", "methodology": "case rate", "standard_charge_dollar": 20617.2 }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 16593.73 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 36300.88, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 96117.39 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 34650.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 34650.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 49501.2, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 33990.82, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "case rate", "standard_charge_dollar": 33990.82, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 34650.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 41251.0, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 19705.05 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 33990.82, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "FRACTURES OF FEMUR WITHOUT MCC", "code_information": [ { "code": "534", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 37480.0, "minimum": 4932.9, "maximum": 60718.41, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 44976.6, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 37480.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 39354.53, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 35606.48, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 37480.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 37480.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 46850.63, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 52472.7, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 60718.41, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 37480.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 37480.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "case rate", "standard_charge_dollar": 37855.31, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "case rate", "standard_charge_dollar": 58094.78, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 12189.58 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 37480.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link Inc HMO", "methodology": "case rate", "standard_charge_dollar": 9270.15 }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 10264.91 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 37480.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 41228.55, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 37480.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 43217.44 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 37480.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 39354.53, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 39354.53, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 56220.75, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 38604.92, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "case rate", "standard_charge_dollar": 38604.92, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 39354.53, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 37480.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 37480.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 46850.63, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 37480.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 37480.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 37480.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 12189.58 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 38604.92, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "FULL THICKNESS BURN WITHOUT SKIN GRAFT OR INHALATION INJURY", "code_information": [ { "code": "934", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 48801.0, "minimum": 7484.4, "maximum": 118516.9, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 58561.32, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 48801.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 51241.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 46361.05, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 48801.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 48801.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 61001.38, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 68321.54, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 79057.78, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 48801.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 48801.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "case rate", "standard_charge_dollar": 49289.11, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "case rate", "standard_charge_dollar": 75641.71, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 16687.52 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 48801.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link Inc HMO", "methodology": "case rate", "standard_charge_dollar": 25421.9 }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 14052.65 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 48801.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 53681.21, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 48801.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 118516.9 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 48801.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 51241.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 51241.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 73201.65, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 50265.13, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "case rate", "standard_charge_dollar": 50265.13, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 51241.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 48801.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 48801.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 61001.38, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 48801.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 48801.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 48801.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 16687.52 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 50265.13, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "GASTROINTESTINAL HEMORRHAGE WITH CC", "code_information": [ { "code": "378", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 33000.0, "minimum": 4932.9, "maximum": 53461.296, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "case rate", "standard_charge_dollar": 39600.96, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 34650.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 31350.76, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "case rate", "standard_charge_dollar": 41251.0, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "case rate", "standard_charge_dollar": 46201.12, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "case rate", "standard_charge_dollar": 53461.3, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "case rate", "standard_charge_dollar": 33330.81, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "case rate", "standard_charge_dollar": 51151.24, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "case rate", "standard_charge_dollar": 20470.17 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link Inc HMO", "methodology": "case rate", "standard_charge_dollar": 11278.05 }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "case rate", "standard_charge_dollar": 17238.04 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "case rate", "standard_charge_dollar": 36300.88, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 52578.27 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "case rate", "standard_charge_dollar": 34650.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "case rate", "standard_charge_dollar": 34650.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 49501.2, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 33990.82, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "case rate", "standard_charge_dollar": 33990.82, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 34650.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "case rate", "standard_charge_dollar": 41251.0, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "case rate", "standard_charge_dollar": 33000.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "case rate", "standard_charge_dollar": 20470.17 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 33990.82, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "HC ACTIVATED PROT C (APC) RESISTNCE ASSAY", "code_information": [ { "code": "85307", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 333.0, "discounted_cash": 15.0, "minimum": 4.17, "maximum": 266.4, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 18.38, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 23.44 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 16.09, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.17 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 14.55, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.17 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 20.68, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 21.45, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 24.82, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.19, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 23.75, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.17 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.62, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.17 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 16.85, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 22.21 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 16.09, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.38 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.09, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 22.98, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.38 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.78, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 15.78, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "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": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.17 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.38 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.15, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.78, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "HC ALPHA-1-ANTITRYPSIN, PHENO", "code_information": [ { "code": "82104", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 125.0, "discounted_cash": 14.0, "minimum": 8.41, "maximum": 100.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 17.35, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 22.12 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 15.18, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.41 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 13.74, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.41 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 19.52, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 20.24, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 23.43, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.68, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 22.41, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.41 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.63, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.41 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 15.91, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.97 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 15.18, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.83 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.18, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.69, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.83 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.89, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 14.89, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "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": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.41 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.35 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.08, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.89, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "HC ALPHA-1-ANTITRYPSIN, TOTAL", "code_information": [ { "code": "82103", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 111.0, "discounted_cash": 13.0, "minimum": 8.064, "maximum": 106.5, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 16.13, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.56 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 14.11, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.41 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 12.77, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.41 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 18.14, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 18.82, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.77, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.06, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 20.83, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.41 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 106.5 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.46, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 89.68 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.41 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.49 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 14.11, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.83 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.11, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 20.16, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.83 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.84, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 13.84, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "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": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.41 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.13 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.8, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 106.5 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.84, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "HC ANGIOTENSIN I ENZYME TEST", "code_information": [ { "code": "82164", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 81.0, "discounted_cash": 14.0, "minimum": 8.41, "maximum": 81.0, "payers_information": [ { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.79, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 81.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.41 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 16.06, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.17 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 15.33, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.83 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.33, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.9, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.83 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.04, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 15.04, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "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": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.41 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.52 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.25, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 81.0 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.04, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 17.52, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 22.34 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 15.33, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.41 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 13.87, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.41 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 19.71, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 20.44, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 23.65, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.76, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 22.63, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.41 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 81.0 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC ANTIBIOTIC SENS,AGAR DIFFUSN,EA", "code_information": [ { "code": "87181", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 31.0, "discounted_cash": 4.0, "minimum": 2.85, "maximum": 24.8, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 5.7, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.27 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 4.99, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.41 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 4.51, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.41 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 6.41, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 6.65, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.7, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.85, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 7.36, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.41 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 24.12 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.46, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 20.31 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.41 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 5.23, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.89 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 4.99, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.78 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.99, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.13, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.78 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.89, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 4.89, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "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": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.41 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.7 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5.94, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 24.12 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.89, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "HC ANTIBIOTIC SENS,MIC,EACH", "code_information": [ { "code": "87186", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 126.0, "discounted_cash": 8.0, "minimum": 5.19, "maximum": 100.8, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 10.38, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.23 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 9.08, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.41 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 8.22, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.41 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 11.68, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.01, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.19, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 13.41, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.41 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 98.55 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.95, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 82.99 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.41 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 9.52, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.54 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 9.08, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.78 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.08, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.98, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.78 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.91, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 8.91, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "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": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.41 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10.38 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.81, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 98.55 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.91, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "HC ANTIHUMAN GLOBULIN INDIRECT EA ANTIBODY TITER", "code_information": [ { "code": "86886", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 252.0, "discounted_cash": 181.0, "minimum": 3.11, "maximum": 252.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 218.02, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.93 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 181.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 190.76, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.11 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 172.6, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.11 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 181.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 181.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 245.27, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 252.0, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 252.0, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 181.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 181.68, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "fee schedule", "standard_charge_dollar": 181.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 252.0, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.11 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 141.45 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 181.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 208.93, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Medicare", "methodology": "fee schedule", "standard_charge_dollar": 181.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 119.11 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.11 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 181.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 199.85, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 181.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.51 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 181.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 190.76, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.27 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 190.76, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 252.0, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.27 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 187.13, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 187.13, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 190.76, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Commercial", "methodology": "fee schedule", "standard_charge_dollar": 181.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 181.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 181.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 181.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.11 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 181.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 181.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.22 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 227.1, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 181.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 181.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 181.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 141.45 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 187.13, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "HC ANTINUCLEAR ANTIBODIES", "code_information": [ { "code": "86038", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 91.0, "discounted_cash": 12.0, "minimum": 7.254, "maximum": 91.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 14.51, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.5 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 12.69, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.1 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 11.49, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.1 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 16.32, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 16.93, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.59, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.25, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 18.74, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.1 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 91.0 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.9, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 91.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.1 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 13.3, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.53 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 12.69, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.51 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.69, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.14, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.51 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.45, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 12.45, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "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": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.1 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.51 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15.11, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 91.0 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.45, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "HC APP SKN SUB TRNK/ARM/LEG TTL 100SQCM 1ST 25 SQCM", "code_information": [ { "code": "15271", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4657.0, "discounted_cash": 788.0, "minimum": 84.67, "maximum": 9902.4, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 945.74, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1020.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 788.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 827.53, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1683.79 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 748.71, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1683.79 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 788.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 788.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 1063.96, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 1103.37, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1276.75, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 788.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 788.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "fee schedule", "standard_charge_dollar": 788.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 1221.59, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1683.79 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 788.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 906.34, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Medicare", "methodology": "fee schedule", "standard_charge_dollar": 788.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1683.79 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 788.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 866.93, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 788.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 788.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 827.53, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1767.98 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 827.53, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1182.18, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1767.98 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 811.76, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 811.76, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 827.53, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Commercial", "methodology": "fee schedule", "standard_charge_dollar": 84.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 788.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 84.67 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 788.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 788.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 1682.95 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1683.79 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 788.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 788.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 985.15, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 788.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 788.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 788.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 811.76, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "HC APP SKN SUB TRNK/ARM/LEG TTL 100SQCM EA AD 25QSQCM", "code_information": [ { "code": "15272", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1607.0, "minimum": 16.95, "maximum": 1607.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 762.0 }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1607.0 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1607.0 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 1607.0 }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1607.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1607.0 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1607.0 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1607.0 }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.95 }, { "payer_name": "Standard EAPG Logic - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 1607.0 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1607.0 } ] } ] }, { "description": "HC AQUAPORIN-4 ANTIBODY ELISA", "code_information": [ { "code": "86051", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 136.0, "discounted_cash": 11.0, "minimum": 6.918, "maximum": 108.8, "payers_information": [ { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.1 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.84 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.41, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.88, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 13.84, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.64 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.1 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 10.95, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.1 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 15.57, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 16.14, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.68, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.92, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 17.87, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.1 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.26, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.1 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 12.68, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.72 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.51 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.3, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.51 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.88, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 11.88, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "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": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC ASPERGILLUS AG EIA", "code_information": [ { "code": "87305", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 102.0, "discounted_cash": 11.0, "minimum": 7.188, "maximum": 81.6, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 14.38, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.33 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 12.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.41 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 11.38, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.41 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 16.17, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.41, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.19, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 18.57, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.41 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.78, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.41 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 13.18, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.37 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 12.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.78 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.97, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.78 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.34, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 12.34, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "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": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.41 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.38 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.98, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.34, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "HC ASPERGILLUS ANTIBODY", "code_information": [ { "code": "86606", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 66.0, "discounted_cash": 15.0, "minimum": 8.1, "maximum": 52.8, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 18.06, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 23.03 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 15.8, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.1 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 14.3, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.1 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 20.32, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 21.07, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 24.38, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.03, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 23.33, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.1 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.31, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.1 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 16.56, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.82 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 15.8, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.51 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.8, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 22.58, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.51 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.5, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 15.5, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "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": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.1 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.06 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.81, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.5, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY ALKALINE PHOSPHATASE ,ISOENZYMES", "code_information": [ { "code": "84080", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 111.0, "discounted_cash": 14.0, "minimum": 8.41, "maximum": 111.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 17.74, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 22.61 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 15.52, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.41 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 14.04, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.41 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 19.95, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 20.69, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 23.94, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.87, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 22.91, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.41 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 111.0 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.0, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 104.29 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.41 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 16.26, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.43 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 15.52, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.83 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.52, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 22.17, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.83 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.22, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 15.22, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "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": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.41 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.74 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.48, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 111.0 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.22, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY GLUCOSE, BODY FLUID", "code_information": [ { "code": "82945", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 58.0, "discounted_cash": 3.0, "minimum": 2.358, "maximum": 58.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 4.72, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.01 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 4.13, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3.73, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 3.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 3.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 5.31, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 5.5, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.37, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.36, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "fee schedule", "standard_charge_dollar": 3.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 6.09, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 58.0 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4.52, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 58.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 4.32, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.7 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 4.13, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.99 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.13, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5.9, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.99 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.05, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 4.05, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "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": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4.72 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4.91, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 3.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 58.0 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.05, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY OF ACTH", "code_information": [ { "code": "82024", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 184.0, "discounted_cash": 38.0, "minimum": 23.172, "maximum": 184.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 46.34, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 59.09 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 40.55, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.6 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 36.69, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.6 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 38.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 38.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 52.14, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 54.07, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 62.56, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.17, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "fee schedule", "standard_charge_dollar": 38.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 59.86, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.6 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 184.0 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 44.41, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 184.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.6 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 42.48, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 56.0 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 40.55, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.83 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.55, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 57.93, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.83 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 39.78, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 39.78, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "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": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Commercial", "methodology": "fee schedule", "standard_charge_dollar": 38.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 45.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 38.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.6 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 38.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 46.34 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 48.28, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 38.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 184.0 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 39.78, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY OF ALDOSTERONE", "code_information": [ { "code": "82088", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 245.0, "discounted_cash": 40.0, "minimum": 24.45, "maximum": 245.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 48.9, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 62.35 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 42.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.6 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 38.71, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.6 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 55.01, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 57.05, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 66.02, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.45, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 63.16, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.6 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 245.0 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 46.86, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 245.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.6 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 44.83, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 59.09 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 42.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.83 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 42.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 61.13, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.83 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 41.97, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 41.97, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "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": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Commercial", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 48.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.6 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 48.9 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 50.94, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 245.0 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 41.97, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY OF APOLIPOPROTEIN", "code_information": [ { "code": "82172", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 212.0, "discounted_cash": 21.0, "minimum": 8.41, "maximum": 169.6, "payers_information": [ { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 85.89 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.41 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 23.2, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 30.58 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 22.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.83 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 31.64, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.83 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.72, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 21.72, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.41 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 25.31 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 26.36, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 101.99 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.72, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 25.31, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 32.27 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 22.14, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.41 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 20.04, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.41 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 28.47, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 29.53, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 34.17, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.65, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 32.69, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.41 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 101.99 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 24.25, "additional_payer_notes": "115.00% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY OF CALCITONIN", "code_information": [ { "code": "82308", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 125.0, "discounted_cash": 26.0, "minimum": 9.28, "maximum": 100.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 32.15, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 40.99 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 28.13, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.28 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.28 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 26.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 26.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 36.17, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 37.51, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 43.4, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.07, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "fee schedule", "standard_charge_dollar": 26.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 41.52, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.28 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 30.81, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.28 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 29.47, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 38.85 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 28.13, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.74 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.13, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.19, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.74 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.59, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 27.59, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.13, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Commercial", "methodology": "fee schedule", "standard_charge_dollar": 26.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 31.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 26.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.28 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 26.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 32.15 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 33.49, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 26.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.59, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "HC (SUP SHELL Q4186) EPIFIX PER SQ CM", "code_information": [ { "code": "Q4186", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "discounted_cash": 126.0, "payers_information": [ { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 5474.1, "10th_percentile": 5000.66, "90th_percentile": 5474.1, "count": "1 through 10" } ] } ] }, { "description": "HC ASSAY OF CERULOPLASMIN", "code_information": [ { "code": "82390", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 74.0, "discounted_cash": 10.0, "minimum": 3.8, "maximum": 74.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 12.89, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.43 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 11.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 10.2, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 14.5, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 15.04, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.4, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.44, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 16.65, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 74.0 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.35, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 74.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 11.81, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.57 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 11.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.99 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.11, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.99 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.06, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 11.06, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.89 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 13.43, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 74.0 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.06, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY OF CK (CPK)", "code_information": [ { "code": "82550", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 86.0, "discounted_cash": 6.0, "minimum": 3.8, "maximum": 82.63, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 7.81, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.96 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 6.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 6.18, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 6.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 6.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 8.79, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 9.11, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.55, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.91, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "fee schedule", "standard_charge_dollar": 6.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 10.09, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 82.63 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.49, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 69.58 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 7.16, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.44 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 6.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.99 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9.77, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.99 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.71, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 6.71, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 6.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.81 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.14, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 6.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 82.63 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.71, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY OF CREATINE", "code_information": [ { "code": "82540", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 125.0, "discounted_cash": 4.0, "minimum": 2.784, "maximum": 100.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 5.57, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.1 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 4.87, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 4.41, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 4.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 4.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 6.26, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 6.5, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.52, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.78, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "fee schedule", "standard_charge_dollar": 4.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 7.19, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.34, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 5.1, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.73 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 4.87, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.99 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.87, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.96, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.99 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.78, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 4.78, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.87, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 4.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.57 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5.8, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 4.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.78, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY OF DIRECT MEASUREMENT FREE ESTRADIOL", "code_information": [ { "code": "82681", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 252.0, "discounted_cash": 27.0, "minimum": 9.28, "maximum": 201.6, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 33.53, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 42.75 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 29.34, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.28 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 26.54, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.28 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 27.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 27.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 37.72, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 39.12, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 45.26, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.76, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "fee schedule", "standard_charge_dollar": 27.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 43.31, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.28 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 32.13, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.28 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 30.73, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 40.51 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 29.34, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.74 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.34, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 41.91, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.74 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.78, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 28.78, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "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": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Commercial", "methodology": "fee schedule", "standard_charge_dollar": 27.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 27.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.28 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 27.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 33.53 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 34.93, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 27.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.78, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY OF FERRITIN", "code_information": [ { "code": "82728", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 132.0, "discounted_cash": 13.0, "minimum": 8.178, "maximum": 132.0, "payers_information": [ { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 132.0 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.04, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 16.36, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.85 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 14.31, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.41 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 12.95, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.41 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 13.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 13.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 19.08, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 22.08, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.18, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "fee schedule", "standard_charge_dollar": 13.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 21.13, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.41 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 132.0 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.67, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 114.28 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.41 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 14.99, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.76 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 14.31, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.83 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.31, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 20.45, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.83 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.04, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 14.04, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.31, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 13.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.41 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.36 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.04, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 13.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.63, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY OF GASTRIN", "code_information": [ { "code": "82941", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 94.0, "discounted_cash": 17.0, "minimum": 9.28, "maximum": 75.2, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 21.16, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 26.97 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 18.51, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.28 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 16.75, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.28 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 17.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 17.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 23.8, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 24.68, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 28.56, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.58, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "fee schedule", "standard_charge_dollar": 17.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 27.33, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.28 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.27, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.28 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 19.39, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 25.56 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 18.51, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.74 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.51, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 26.45, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.74 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.16, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 18.16, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.51, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 17.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.28 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 17.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.16 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 22.04, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 17.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.16, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "HC ACTIN SMOOTH MUSCLE ANTIBODY EACH", "code_information": [ { "code": "86015", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 60.0, "discounted_cash": 12.0, "minimum": 7.23, "maximum": 48.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.64 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 12.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.1 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 11.45, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.1 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 16.27, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.52, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.23, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 18.68, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.1 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.86, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.1 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 13.26, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.47 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 12.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.51 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.08, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.51 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.41, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 12.41, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "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": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.1 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.46 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15.06, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.41, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY OF HOMOCYSTINE", "code_information": [ { "code": "83090", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 146.0, "discounted_cash": 17.0, "minimum": 9.28, "maximum": 146.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 21.5, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 27.42 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 18.82, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.28 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 17.02, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.28 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 17.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 17.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 24.19, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 25.09, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 29.03, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.75, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "fee schedule", "standard_charge_dollar": 17.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 27.78, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.28 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 146.0 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.61, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 142.85 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.28 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 19.71, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 25.98 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 18.82, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.74 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.82, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 26.88, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.74 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.46, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 18.46, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "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": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 17.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.28 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 17.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.5 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 22.4, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 17.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 146.0 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.46, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "HC ADMIN INFLUENZA VIRUS VAC - G0008 - 77100008 - 77100008", "code_information": [ { "code": "G0008", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 90.0, "discounted_cash": 49.0, "minimum": 15.0, "maximum": 80.8704, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 59.9, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 49.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 52.42, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 33.69 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 47.42, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 33.69 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 49.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 49.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 67.39, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 69.89, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 80.87, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 49.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 49.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "fee schedule", "standard_charge_dollar": 49.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 77.38, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 33.69 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 49.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 57.41, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Medicare", "methodology": "fee schedule", "standard_charge_dollar": 49.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 33.69 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 49.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 54.91, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 49.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 49.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 52.42, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 35.37 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 52.42, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 74.88, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 35.37 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 51.42, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 51.42, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 52.42, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Commercial", "methodology": "fee schedule", "standard_charge_dollar": 49.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 49.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 49.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 49.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 33.67 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 33.69 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 49.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 49.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 62.4, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 49.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 34.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 49.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 51.42, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY OF LIPASE", "code_information": [ { "code": "83690", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 99.0, "discounted_cash": 6.0, "minimum": 3.8, "maximum": 99.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 8.27, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10.54 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 7.23, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 6.55, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 6.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 6.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 9.3, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 9.65, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.13, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "fee schedule", "standard_charge_dollar": 6.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 10.68, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 99.0 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.92, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 84.9 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 7.58, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.99 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 7.23, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.99 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.23, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.34, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.99 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.1, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 7.1, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.23, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 6.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.27 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.61, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 6.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 99.0 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.1, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "HC ADMIN PNEUMOCOCCAL VAC - G0009 - 77100009 - 77100009", "code_information": [ { "code": "G0009", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 87.0, "discounted_cash": 49.0, "minimum": 15.0, "maximum": 80.8704, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 59.9, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 49.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 52.42, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 33.69 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 47.42, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 33.69 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 49.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 49.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 67.39, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 69.89, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 80.87, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 49.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 49.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "fee schedule", "standard_charge_dollar": 49.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 77.38, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 33.69 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 49.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 57.41, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Medicare", "methodology": "fee schedule", "standard_charge_dollar": 49.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 33.69 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 49.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 54.91, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 49.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 49.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 52.42, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 35.37 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 52.42, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 74.88, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 35.37 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 51.42, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 51.42, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 52.42, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Commercial", "methodology": "fee schedule", "standard_charge_dollar": 49.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 49.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 49.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 49.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 33.67 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 33.69 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 49.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 49.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 62.4, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 49.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 33.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 49.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 51.42, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY OF LIPOPROTEIN(A)", "code_information": [ { "code": "83695", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 212.0, "discounted_cash": 14.0, "minimum": 8.41, "maximum": 169.6, "payers_information": [ { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 14.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.41 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.18 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.9, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 14.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.75, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 17.18, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.91 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 15.04, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.41 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 13.6, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.41 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 14.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 14.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 19.33, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 20.05, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 23.2, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.59, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "fee schedule", "standard_charge_dollar": 14.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 22.2, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.41 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.47, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.41 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 15.75, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.76 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 15.04, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.83 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.04, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.48, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.83 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.75, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 14.75, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.04, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "HC AG DETECT NOS, EIA, MULT STEP", "code_information": [ { "code": "87449", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 68.0, "discounted_cash": 11.0, "minimum": 7.188, "maximum": 68.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 14.38, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.33 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 12.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.41 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 11.38, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.41 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 16.17, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.41, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.19, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 18.57, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.41 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 68.0 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.78, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 68.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.41 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 13.18, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.37 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 12.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.78 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.97, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.78 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.34, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 12.34, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "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": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.41 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.38 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.98, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 68.0 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.34, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY OF LITHIUM", "code_information": [ { "code": "80178", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 78.0, "discounted_cash": 6.0, "minimum": 3.966, "maximum": 78.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 7.93, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10.11 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 6.94, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.53 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 6.28, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.53 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 6.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 6.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 8.92, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 9.25, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.71, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.97, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "fee schedule", "standard_charge_dollar": 6.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 10.25, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.53 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 78.0 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.6, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 78.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.53 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 7.27, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.58 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 6.94, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.96 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.94, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9.92, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.96 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.81, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 6.81, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "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": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 6.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.53 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.93 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.26, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 6.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 78.0 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.81, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "HC AIRWAY INHALATION TREATMENT", "code_information": [ { "code": "94640", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 443.0, "discounted_cash": 233.0, "minimum": 9.16, "maximum": 443.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 280.2, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 233.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 245.18, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 49.94 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 221.83, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 49.94 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 233.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 233.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 315.23, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 326.9, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 378.27, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 233.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 233.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "fee schedule", "standard_charge_dollar": 233.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 361.93, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 49.94 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 233.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 268.53, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Medicare", "methodology": "fee schedule", "standard_charge_dollar": 233.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 49.94 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 233.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 256.85, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 233.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 145.0 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 233.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 245.18, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 52.44 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 245.18, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 350.25, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 52.44 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 240.51, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 240.51, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 245.18, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 233.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.16 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 233.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 233.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 49.94 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 233.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 233.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 443.0 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 291.88, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 233.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 233.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 233.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 240.51, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "HC ABDOM PARACENTESIS DX/THER W IMAGING GUIDANCE", "code_information": [ { "code": "49083", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1318.0, "discounted_cash": 967.0, "minimum": 102.5, "maximum": 1318.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 1160.62, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1020.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 967.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 1015.54, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 625.68 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 918.82, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 625.68 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 967.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 967.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 1305.69, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 1318.0, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1318.0, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 967.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 967.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "fee schedule", "standard_charge_dollar": 967.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 1318.0, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 625.68 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 967.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1112.26, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Medicare", "methodology": "fee schedule", "standard_charge_dollar": 967.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 625.68 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 967.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 1063.9, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 967.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 967.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 1015.54, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 656.96 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1015.54, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1318.0, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 656.96 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 996.2, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 996.2, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1015.54, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Commercial", "methodology": "fee schedule", "standard_charge_dollar": 102.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 967.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 102.5 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 967.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 967.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 625.36 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 625.68 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 967.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 967.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1208.98, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 967.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 967.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 967.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 996.2, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY OF PHENOBARBITAL", "code_information": [ { "code": "80184", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 99.0, "discounted_cash": 15.0, "minimum": 8.53, "maximum": 99.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 18.36, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 23.41 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 16.07, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.53 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 14.54, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.53 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 15.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 15.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 20.66, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 21.42, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 24.79, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.18, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "fee schedule", "standard_charge_dollar": 15.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 23.72, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.53 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 99.0 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.6, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 99.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.53 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 16.83, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 22.19 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 16.07, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.96 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.07, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 22.95, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.96 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.76, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 15.76, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.07, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 15.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.53 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 15.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.36 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.13, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 15.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 99.0 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.76, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "HC ALLERGEN SPEC IGE QUANT,EACH", "code_information": [ { "code": "86003", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 27.0, "discounted_cash": 5.0, "minimum": 3.132, "maximum": 27.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 6.26, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.99 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 5.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.1 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 4.96, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.1 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 7.05, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 7.31, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.46, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.13, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 8.09, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.1 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 27.0 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.0, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 27.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.1 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 5.74, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.57 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 5.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.51 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.83, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.51 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.38, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 5.38, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "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": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.1 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.26 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.53, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 27.0 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.38, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "HC AGENT NOS ASSAY W/OPTIC", "code_information": [ { "code": "87899", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 88.0, "discounted_cash": 16.0, "minimum": 7.41, "maximum": 73.17, "payers_information": [ { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.48, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 61.62 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.41 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 17.68, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 23.3 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.78 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 24.11, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.78 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.55, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 16.55, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "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": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 16.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.41 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.28 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 20.09, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 16.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 73.17 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.55, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 19.28, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 24.59 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.41 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 15.27, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.41 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 16.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 16.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 21.69, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 22.5, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 26.03, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.64, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "fee schedule", "standard_charge_dollar": 16.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 24.91, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.41 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 73.17 } ] } ] }, { "description": "HC ASSAY OF PROSTATE SPECIFIC ANTIGEN TOTAL - 84153 - 30100312", "code_information": [ { "code": "84153", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 159.0, "discounted_cash": 18.0, "minimum": 8.41, "maximum": 138.8, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 22.07, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 28.14 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 19.31, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.41 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 17.47, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.41 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 18.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 18.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 24.83, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 25.75, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 29.79, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 69.0, "median_amount": 109.71, "10th_percentile": 109.71, "90th_percentile": 109.71, "count": "1 through 10" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.03, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "fee schedule", "standard_charge_dollar": 18.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 28.5, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.41 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 138.8 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.15, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 116.88 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.41 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 20.23, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 26.67 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 19.31, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.83 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.31, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 27.59, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.83 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.94, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 18.94, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "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": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 18.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.41 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 22.07 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 22.99, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 18.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 138.8 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.94, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "HC ALPHA-FETOPROTEIN; AMNIOTIC", "code_information": [ { "code": "82106", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 91.0, "discounted_cash": 17.0, "minimum": 8.41, "maximum": 91.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 20.4, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 26.01 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 17.85, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.41 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 16.15, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.41 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 17.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 17.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 22.95, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 23.8, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 27.54, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.2, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "fee schedule", "standard_charge_dollar": 17.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 26.35, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.41 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 91.0 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.55, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 91.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.41 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 18.7, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 24.65 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 17.85, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.83 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.85, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 25.5, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.83 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.51, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 17.51, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.85, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 17.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.41 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 17.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.4 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.25, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 17.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 91.0 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.51, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "HC ALLERGEN SPEC IGE RECOMBINANT/PURIFIED COMPNT EA", "code_information": [ { "code": "86008", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 90.0, "discounted_cash": 17.0, "minimum": 8.1, "maximum": 72.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 21.52, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 27.43 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 18.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.1 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 17.03, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.1 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 24.21, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 25.1, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 29.05, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.76, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 27.79, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.1 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.62, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.1 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 19.72, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 26.0 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 18.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.51 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.83, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 26.9, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.51 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.47, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 18.47, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "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": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.1 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.52 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 22.41, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.47, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY OF SEROTONIN", "code_information": [ { "code": "84260", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 127.0, "discounted_cash": 30.0, "minimum": 18.588, "maximum": 101.6, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 37.18, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 47.4 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 32.53, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.6 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 29.43, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.6 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 30.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 30.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 41.82, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 43.37, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 50.19, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.59, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "fee schedule", "standard_charge_dollar": 30.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 48.02, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.6 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 35.63, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.6 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 34.08, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 44.92 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 32.53, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.83 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 32.53, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 46.47, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.83 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 31.91, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 31.91, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "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": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Commercial", "methodology": "fee schedule", "standard_charge_dollar": 30.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 30.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.6 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 30.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 37.18 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 38.73, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 30.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 31.91, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "HC ANTB SEVERE AQT RESPIR SYND SARS-COV-2 COVID19", "code_information": [ { "code": "86769", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 205.0, "discounted_cash": 42.0, "minimum": 8.1, "maximum": 164.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 50.56, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 64.46 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 42.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 44.24, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.1 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 40.02, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.1 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 42.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 42.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 56.88, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 58.98, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 68.25, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 42.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.28, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "fee schedule", "standard_charge_dollar": 42.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 65.3, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.1 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 42.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 48.45, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Medicare", "methodology": "fee schedule", "standard_charge_dollar": 42.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.1 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 42.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 46.34, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 42.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 61.09 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 42.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 44.24, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.51 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 44.24, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 63.2, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.51 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 43.39, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 43.39, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 44.24, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Commercial", "methodology": "fee schedule", "standard_charge_dollar": 42.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 42.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 42.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 42.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.1 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 42.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 42.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 50.56 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 52.66, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 42.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 42.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 42.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 43.39, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "HC ALPHA-FETOPROTEIN, SERUM", "code_information": [ { "code": "82105", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 380.0, "discounted_cash": 16.0, "minimum": 8.41, "maximum": 304.0, "payers_information": [ { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 20.12, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 25.66 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 17.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.41 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 15.93, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.41 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 22.64, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 23.48, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 27.17, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.06, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 25.99, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.41 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 153.53 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.29, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 129.29 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.41 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 18.45, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 24.32 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 17.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.83 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 25.16, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.83 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "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": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.41 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.12 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 20.96, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 153.53 } ] } ] }, { "description": "HC ANTIBODY DETECTION NOS IF", "code_information": [ { "code": "87299", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 115.0, "discounted_cash": 16.0, "minimum": 7.41, "maximum": 92.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 19.32, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 24.63 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 16.91, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.41 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 15.3, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.41 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 16.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 16.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 21.74, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 22.54, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 26.08, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.66, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "fee schedule", "standard_charge_dollar": 16.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 24.96, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.41 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 81.4 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.52, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 68.54 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.41 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 17.71, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 23.35 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 16.91, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.78 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.91, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 24.15, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.78 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.58, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 16.58, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.91, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 16.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.41 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.32 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 20.13, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 16.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 81.4 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.58, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY OF TESTOSTERONE", "code_information": [ { "code": "84402", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 493.0, "discounted_cash": 25.0, "minimum": 9.28, "maximum": 394.4, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 30.56, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 38.97 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 26.74, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.28 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 24.2, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.28 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 25.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 25.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 34.38, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 35.66, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 41.26, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.28, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "fee schedule", "standard_charge_dollar": 25.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 39.48, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.28 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 134.34 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 29.29, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 113.13 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.28 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 28.02, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 36.93 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 26.74, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.74 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.74, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 38.21, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.74 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.23, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 26.23, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "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": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Commercial", "methodology": "fee schedule", "standard_charge_dollar": 25.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 30.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 25.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.28 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 25.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 30.56 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 31.84, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 25.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 134.34 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.23, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "HC ANTIBIOTIC SENS,ENZYME DETECTION,EACH", "code_information": [ { "code": "87185", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 38.0, "discounted_cash": 4.0, "minimum": 2.85, "maximum": 30.4, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 5.7, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.27 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 4.99, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.41 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 4.51, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.41 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 6.41, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 6.65, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.7, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.85, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 7.36, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.41 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 28.54 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.46, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 24.03 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.41 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 5.23, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.89 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 4.99, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.78 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.99, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.13, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.78 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.89, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 4.89, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "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": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.41 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.7 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5.94, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 28.54 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.89, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "HC ANTIBODY TREPONEMA PALLIDUM", "code_information": [ { "code": "86780", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 66.0, "discounted_cash": 13.0, "minimum": 7.944, "maximum": 52.8, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 15.89, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.26 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 13.9, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.1 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 12.58, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.1 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 13.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 13.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 17.87, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 18.54, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.45, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 69.0, "median_amount": 45.54, "10th_percentile": 45.54, "90th_percentile": 45.54, "count": "1 through 10" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.94, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "fee schedule", "standard_charge_dollar": 13.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 20.52, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.1 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.23, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.1 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 14.56, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.2 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 13.9, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.51 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.9, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.86, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.51 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.64, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 13.64, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "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": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 13.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.1 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.89 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.55, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 13.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.64, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "HC ANTIHUMAN GLOBULIN DIR EA ANTISERUM", "code_information": [ { "code": "86880", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 75.0, "discounted_cash": 62.0, "minimum": 3.11, "maximum": 75.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 75.0, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.25 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 62.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 66.05, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.11 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 59.76, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.11 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 62.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 62.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 75.0, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 75.0, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 75.0, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 62.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 62.9, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "fee schedule", "standard_charge_dollar": 62.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 75.0, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.11 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 57.89 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 62.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 72.34, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Medicare", "methodology": "fee schedule", "standard_charge_dollar": 62.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 48.75 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.11 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 62.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 69.19, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 62.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.82 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 62.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 66.05, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.27 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 66.05, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 75.0, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.27 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.79, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 64.79, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 66.05, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Commercial", "methodology": "fee schedule", "standard_charge_dollar": 62.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 62.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 62.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 62.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.11 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 62.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 62.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.47 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 75.0, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 62.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 62.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 62.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 57.89 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.79, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY OF THEOPHYLLINE", "code_information": [ { "code": "80198", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 121.0, "discounted_cash": 14.0, "minimum": 8.484, "maximum": 121.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 16.97, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.63 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 14.85, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.53 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 13.43, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.53 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 14.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 14.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 19.09, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 19.8, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 22.91, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.48, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "fee schedule", "standard_charge_dollar": 14.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 21.92, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.53 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 121.0 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.26, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 111.7 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.53 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 15.55, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.5 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 14.85, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.96 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.85, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.21, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.96 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.56, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 14.56, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "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": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 14.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.53 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.97 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.68, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 14.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 121.0 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.56, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "HC ANTINUCLEAR ANTIBODIES TITER", "code_information": [ { "code": "86039", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 75.0, "discounted_cash": 11.0, "minimum": 6.696, "maximum": 75.0, "payers_information": [ { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 11.72, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.51 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.72, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.74, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.51 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.49, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 11.49, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.72, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.1 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.39 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 13.95, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 75.0 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.49, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 13.39, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.07 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 11.72, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.1 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 10.6, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.1 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 15.07, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 15.62, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.08, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.7, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 17.3, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.1 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 75.0 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.83, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 75.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.1 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 12.28, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.18 } ] } ] }, { "description": "HC ANTINEUTROPHIL CYTOPLASMIC ANTB SCREEN EA ANTB", "code_information": [ { "code": "86036", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 60.0, "discounted_cash": 12.0, "minimum": 7.23, "maximum": 48.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.44 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 12.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.1 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 11.45, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.1 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 16.27, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.52, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.23, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 18.68, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.1 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.86, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.1 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 13.26, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.47 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 12.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.51 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.08, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.51 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.41, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 12.41, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "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": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.1 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.46 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15.06, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.41, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "HC APP SKN SUB HEAD/HND/FT/GNT TTL 100SQCM 1ST 25 SQCM", "code_information": [ { "code": "15275", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5835.0, "discounted_cash": 788.0, "minimum": 93.33, "maximum": 4668.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 945.74, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1020.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 788.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 827.53, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1683.79 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 748.71, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1683.79 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 788.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 788.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 1063.96, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 1103.37, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1276.75, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 788.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 788.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "fee schedule", "standard_charge_dollar": 788.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 1221.59, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1683.79 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 788.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 906.34, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Medicare", "methodology": "fee schedule", "standard_charge_dollar": 788.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1683.79 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 788.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 866.93, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 788.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 788.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 827.53, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1767.98 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 827.53, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1182.18, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1767.98 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 811.76, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 811.76, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 827.53, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Commercial", "methodology": "fee schedule", "standard_charge_dollar": 93.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 788.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 93.33 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 788.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 788.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 1682.95 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1683.79 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 788.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 788.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 985.15, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 788.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 788.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 788.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 811.76, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY OF THYROID STIM IMMUNOGLOBULINS (TSI)", "code_information": [ { "code": "84445", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 182.0, "discounted_cash": 50.0, "minimum": 24.6, "maximum": 182.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 61.03, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 77.82 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 50.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 53.4, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.6 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 48.32, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.6 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 50.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 50.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 68.66, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 71.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 82.39, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 50.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30.52, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "fee schedule", "standard_charge_dollar": 50.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 78.83, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.6 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 182.0 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 50.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 58.49, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Medicare", "methodology": "fee schedule", "standard_charge_dollar": 50.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 165.53 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.6 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 50.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 55.95, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 50.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 73.75 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 50.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 53.4, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.83 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 53.4, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 76.29, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.83 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 52.39, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 52.39, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "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": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Commercial", "methodology": "fee schedule", "standard_charge_dollar": 50.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 50.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 59.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 50.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 50.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.6 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 50.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 50.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 61.03 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 63.58, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 50.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 50.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 50.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 182.0 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 52.39, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "HC APPLY RIGID LEG CAST", "code_information": [ { "code": "29445", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 768.0, "discounted_cash": 298.0, "minimum": 99.7, "maximum": 768.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 357.9, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 298.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 313.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 155.94 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 283.34, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 155.94 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 298.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 298.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 402.64, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 417.55, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 483.17, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 298.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 768.0 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 298.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "fee schedule", "standard_charge_dollar": 298.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 462.29, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 155.94 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 298.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 342.99, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Medicare", "methodology": "fee schedule", "standard_charge_dollar": 298.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 155.94 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 298.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 328.08, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 298.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 298.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 313.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 163.74 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 313.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 447.38, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 163.74 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 307.2, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 307.2, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 313.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Commercial", "methodology": "fee schedule", "standard_charge_dollar": 99.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 298.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 99.7 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 298.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 298.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 155.94 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 298.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 298.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 372.81, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 298.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 298.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 298.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 307.2, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "HC ANTINEUTROPHIL CYTOPLASMIC ANTB TITER EA ANTB", "code_information": [ { "code": "86037", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 44.0, "discounted_cash": 12.0, "minimum": 7.23, "maximum": 35.2, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.44 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 12.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.1 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 11.45, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.1 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 16.27, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.52, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.23, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 18.68, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.1 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.86, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.1 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 13.26, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.47 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 12.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.51 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.08, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.51 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.41, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 12.41, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "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": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.1 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.46 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15.06, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.41, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "HC APP SKN SUB HEAD/HND/FT/GNT TTL 100SQCM EA AD 25CM", "code_information": [ { "code": "15276", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 785.0, "minimum": 25.2, "maximum": 785.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 762.0 }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 785.0 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 785.0 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 785.0 }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 785.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 785.0 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 785.0 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 785.0 }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Commercial", "methodology": "fee schedule", "standard_charge_dollar": 25.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 25.2 }, { "payer_name": "Standard EAPG Logic - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 785.0 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 785.0 } ] } ] }, { "description": "HC ASSAY OF THYROXINE BNDNG GLOBULIN", "code_information": [ { "code": "84442", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 82.0, "discounted_cash": 14.0, "minimum": 8.868, "maximum": 82.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 17.74, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 22.61 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 15.52, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.28 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 14.04, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.28 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 19.95, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 20.69, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 23.94, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.87, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 22.91, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.28 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 82.0 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.0, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 76.24 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.28 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 16.26, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.43 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 15.52, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.74 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.52, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 22.17, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.74 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.22, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 15.22, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "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": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.28 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.74 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.48, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 82.0 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.22, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "HC ARC BLOOD TYPING, RH (D)", "code_information": [ { "code": "86901", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 42.0, "discounted_cash": 39.0, "minimum": 3.11, "maximum": 42.0, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 41.81, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 37.83, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 39.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 39.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 42.0, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 42.0, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 42.0, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 39.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 39.82, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "fee schedule", "standard_charge_dollar": 39.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 42.0, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 42.0 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 39.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 42.0, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Medicare", "methodology": "fee schedule", "standard_charge_dollar": 39.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 37.37 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 39.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 42.0, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 39.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4.34 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 39.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 41.81, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 41.81, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 42.0, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 41.01, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 41.01, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 41.81, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Commercial", "methodology": "fee schedule", "standard_charge_dollar": 39.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 39.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 39.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 39.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 39.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 39.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3.59 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 42.0, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 39.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 39.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 39.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 42.0 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 41.01, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 42.0, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4.57 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 39.82, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC ANTISTREPTOLYSIN O TITER", "code_information": [ { "code": "86060", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 168.0, "discounted_cash": 7.0, "minimum": 4.38, "maximum": 134.4, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 8.76, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.17 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 7.67, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.1 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 6.94, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.1 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 7.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 7.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 9.86, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 10.22, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11.83, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.38, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "fee schedule", "standard_charge_dollar": 7.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 11.32, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.1 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 98.75 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.4, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 83.16 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.1 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 8.03, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10.59 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 7.67, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.51 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.67, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.95, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.51 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.52, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 7.52, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "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": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 7.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.1 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.76 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9.13, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 7.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 98.75 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.52, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "HC ARC RBC PRETREATMENT/CHEM OR DRUGS", "code_information": [ { "code": "86970", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 206.0, "discounted_cash": 62.0, "minimum": 20.0, "maximum": 164.8, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 75.48, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 42.37 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 62.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 66.05, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 73.48 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 59.76, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 73.48 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 62.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 62.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 84.92, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 88.06, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 101.9, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 62.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 62.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "fee schedule", "standard_charge_dollar": 62.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 97.5, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 73.48 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 62.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 72.34, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Medicare", "methodology": "fee schedule", "standard_charge_dollar": 62.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 73.48 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 62.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 69.19, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 62.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 62.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 66.05, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 77.15 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 66.05, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 94.35, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 77.15 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.79, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 64.79, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 66.05, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Commercial", "methodology": "fee schedule", "standard_charge_dollar": 62.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 62.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 62.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 62.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 73.48 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 62.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 62.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 71.28 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 78.63, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 62.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 42.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 62.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.79, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY OF TOBRAMYCIN", "code_information": [ { "code": "80200", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 173.0, "discounted_cash": 16.0, "minimum": 8.53, "maximum": 138.4, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 19.36, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 24.68 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 16.94, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.53 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.53 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 16.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 16.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 21.78, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 22.58, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 26.13, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.68, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "fee schedule", "standard_charge_dollar": 16.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 25.0, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.53 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 83.38 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.55, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 70.22 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.53 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 17.74, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 23.39 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 16.94, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.96 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.94, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 24.2, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.96 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.61, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 16.61, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.94, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 16.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.53 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.36 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 20.16, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 16.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 83.38 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.61, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "HC ARC RBC ANTIBODY ELUTION", "code_information": [ { "code": "86860", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 218.0, "discounted_cash": 181.0, "minimum": 24.0, "maximum": 218.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 218.0, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 45.76 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 181.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 190.76, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 113.96 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 172.6, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 113.96 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 181.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 181.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 218.0, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 218.0, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 218.0, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 181.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 181.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "fee schedule", "standard_charge_dollar": 181.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 218.0, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 113.96 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 181.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 208.93, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Medicare", "methodology": "fee schedule", "standard_charge_dollar": 181.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 113.96 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 181.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 199.85, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 181.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 181.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 190.76, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 119.66 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 190.76, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 218.0, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 119.66 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 187.13, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 187.13, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 190.76, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Commercial", "methodology": "fee schedule", "standard_charge_dollar": 181.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 181.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 24.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 181.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 181.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 113.96 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 181.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 181.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 205.63 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 218.0, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 181.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 133.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 181.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 187.13, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "HC ANTITHROMBIN III TEST,ACTIV", "code_information": [ { "code": "85300", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 644.0, "discounted_cash": 11.0, "minimum": 3.11, "maximum": 515.2, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 14.22, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.13 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 12.44, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.11 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 11.26, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.11 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 16.0, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 16.59, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.2, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.11, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 18.37, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.11 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 229.84 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.63, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 193.55 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.11 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 13.04, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.18 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 12.44, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.27 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.44, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.78, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.27 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.21, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 12.21, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "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": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.11 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.22 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.81, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 229.84 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.21, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "HC ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/US", "code_information": [ { "code": "20611", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1045.0, "discounted_cash": 327.0, "minimum": 56.46, "maximum": 1045.0, "payers_information": [ { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 397.87 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 327.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 327.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 409.15, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 327.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 327.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 327.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 337.14, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 392.78, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 762.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 327.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 343.69, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 397.87 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 310.95, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 397.87 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 327.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 327.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 441.88, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 458.25, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 530.26, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 327.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 1045.0 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 327.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "fee schedule", "standard_charge_dollar": 327.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 507.35, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 397.87 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 327.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 376.42, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Medicare", "methodology": "fee schedule", "standard_charge_dollar": 327.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 397.87 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 327.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 360.05, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 327.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 327.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 343.69, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 417.76 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 343.69, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 490.98, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 417.76 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 337.14, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 337.14, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 343.69, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Commercial", "methodology": "fee schedule", "standard_charge_dollar": 56.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 327.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 56.46 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 327.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 327.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 397.68 } ] } ] }, { "description": "HC ASSAY OF TOTAL THYROXINE", "code_information": [ { "code": "84436", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 120.0, "discounted_cash": 6.0, "minimum": 4.122, "maximum": 96.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 8.24, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10.51 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 7.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.28 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 6.53, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.28 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 6.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 6.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 9.27, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 9.62, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11.13, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.12, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "fee schedule", "standard_charge_dollar": 6.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 10.65, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.28 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 89.55 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.9, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 75.41 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.28 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 7.56, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.96 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 7.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.74 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.31, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.74 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.08, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 7.08, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 6.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.28 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.24 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.59, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 6.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 89.55 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.08, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "HC ARC RBC ANTIBODY IDENTIFICATION", "code_information": [ { "code": "86870", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 419.0, "discounted_cash": 382.0, "minimum": 37.0, "maximum": 419.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 419.0, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 62.32 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 382.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 401.34, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 113.96 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 363.12, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 113.96 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 382.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 382.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 419.0, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 419.0, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 419.0, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 382.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 382.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "fee schedule", "standard_charge_dollar": 382.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 419.0, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 113.96 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 214.67 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 382.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 419.0, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Medicare", "methodology": "fee schedule", "standard_charge_dollar": 382.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 180.78 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 113.96 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 382.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 419.0, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 382.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 382.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 401.34, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 119.66 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.34, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 419.0, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 119.66 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 393.7, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 393.7, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.34, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Commercial", "methodology": "fee schedule", "standard_charge_dollar": 382.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 382.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 37.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 382.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 382.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 113.96 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 382.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 382.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 419.0 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 419.0, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 382.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 135.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 382.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 214.67 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 393.7, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "HC APPLY MULTLAY COMPRS LWR LEG", "code_information": [ { "code": "29581", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 438.0, "discounted_cash": 173.0, "minimum": 23.63, "maximum": 438.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 207.94, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 181.94, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 155.94 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 164.62, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 155.94 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 173.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 173.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 233.93, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 242.59, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 280.71, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 438.0 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "fee schedule", "standard_charge_dollar": 173.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 268.58, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 155.94 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 199.27, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 155.94 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 190.61, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 131.4, "10th_percentile": 131.4, "90th_percentile": 131.4, "count": "15" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 181.94, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 163.74 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 181.94, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 259.92, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 163.74 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 178.48, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 178.48, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 181.94, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Commercial", "methodology": "fee schedule", "standard_charge_dollar": 23.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 23.63 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 173.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 155.94 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 173.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 216.6, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 173.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 173.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 178.48, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY ALKALINE PHOSPHATASE", "code_information": [ { "code": "84075", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 45.0, "discounted_cash": 5.0, "minimum": 3.108, "maximum": 45.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 6.22, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.93 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 5.44, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 4.92, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 6.99, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 7.25, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.39, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.11, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 8.03, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 45.0 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.96, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 45.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 5.7, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.51 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 5.44, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.99 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.44, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.77, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.99 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.34, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 5.34, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "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": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.22 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 45.0 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.34, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY OF TRANSFERRIN", "code_information": [ { "code": "84466", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 86.0, "discounted_cash": 12.0, "minimum": 7.656, "maximum": 86.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 15.31, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.52 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 13.4, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.41 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 12.12, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.41 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 12.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 12.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 17.23, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 17.86, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 20.67, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.66, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "fee schedule", "standard_charge_dollar": 12.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 19.78, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.41 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 86.0 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.67, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 86.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.41 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 14.04, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.5 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 13.4, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.83 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.4, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.14, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.83 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.14, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 13.14, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.4, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 12.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.41 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.31 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15.95, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 12.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 86.0 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.14, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "HC ARC RBC ANTIBODY SCREEN", "code_information": [ { "code": "86850", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 153.0, "discounted_cash": 55.0, "minimum": 3.11, "maximum": 122.4, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 66.68, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.95 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 55.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 58.35, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.11 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 52.79, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.11 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 55.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 55.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 75.02, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 77.8, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 90.02, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 55.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 55.57, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "fee schedule", "standard_charge_dollar": 55.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 86.13, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.11 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 99.2 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 55.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 63.91, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Medicare", "methodology": "fee schedule", "standard_charge_dollar": 55.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 83.54 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.11 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 55.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 61.13, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 55.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.17 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 55.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 58.35, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.27 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.35, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 83.36, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.27 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 57.24, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 57.24, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 58.35, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Commercial", "methodology": "fee schedule", "standard_charge_dollar": 55.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 55.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 55.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 55.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.11 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 55.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 55.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.72 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 69.46, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 55.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 55.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 55.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 99.2 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 57.24, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "HC AQUATIC THERAPY/EXERCISES EA 15 MIN", "code_information": [ { "code": "97113", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 256.0, "discounted_cash": 37.0, "minimum": 31.26, "maximum": 256.0, "payers_information": [ { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 37.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 41.49, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 37.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 145.0 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 37.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 39.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 32.82 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 39.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 56.58, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 32.82 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.85, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 38.85, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 39.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Commercial", "methodology": "fee schedule", "standard_charge_dollar": 37.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 37.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 37.72 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 37.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 37.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.26 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 37.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 37.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 256.0 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 47.15, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 37.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 38.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 37.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 131.6 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.85, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 45.26, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 37.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 39.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.26 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 35.83, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.26 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 37.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 37.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 50.92, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 52.81, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 61.11, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 37.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 37.72 }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "fee schedule", "standard_charge_dollar": 37.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 58.47, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.26 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 131.6 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 37.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 43.38, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Medicare", "methodology": "fee schedule", "standard_charge_dollar": 37.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 110.82 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.26 } ] } ] }, { "description": "HC ASSAY OF ALUMINUM", "code_information": [ { "code": "82108", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 84.0, "discounted_cash": 25.0, "minimum": 8.66, "maximum": 84.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 30.58, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 38.98 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 26.75, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.66 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 24.21, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.66 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 25.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 25.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 34.4, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 35.67, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 41.28, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.29, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "fee schedule", "standard_charge_dollar": 25.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 39.49, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.66 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 84.0 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 29.3, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 84.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.66 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 28.03, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 36.95 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 26.75, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.09 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.75, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 38.22, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.09 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.24, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 26.24, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.75, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Commercial", "methodology": "fee schedule", "standard_charge_dollar": 25.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 30.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 25.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.66 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 25.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 30.58 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 31.85, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 25.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 84.0 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.24, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY OF URINE SODIUM", "code_information": [ { "code": "84300", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 43.0, "discounted_cash": 5.0, "minimum": 3.036, "maximum": 43.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 6.07, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.74 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 5.31, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 4.81, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 5.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 5.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 6.83, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 7.08, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.2, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.04, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "fee schedule", "standard_charge_dollar": 5.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 7.84, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 43.0 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.82, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 43.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 5.57, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.34 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 5.31, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.99 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.31, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.59, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.99 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.21, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 5.21, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.31, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 5.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.07 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.33, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 5.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 43.0 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.21, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "HC ARC RBC PRETREATMENT/ENZYM", "code_information": [ { "code": "86971", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 573.0, "discounted_cash": 181.0, "minimum": 33.5988, "maximum": 458.4, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 218.02, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 33.6 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 181.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 190.76, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 73.48 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 172.6, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 73.48 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 181.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 181.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 245.27, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 254.35, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 294.32, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 181.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 181.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "fee schedule", "standard_charge_dollar": 181.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 281.6, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 73.48 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 181.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 208.93, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Medicare", "methodology": "fee schedule", "standard_charge_dollar": 181.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 73.48 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 181.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 199.85, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 181.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 181.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 190.76, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 77.15 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 190.76, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 272.52, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 77.15 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 187.13, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 187.13, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 190.76, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Commercial", "methodology": "fee schedule", "standard_charge_dollar": 181.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 181.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 181.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 181.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 73.48 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 181.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 181.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 205.63 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 227.1, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 181.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 110.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 181.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 187.13, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "HC ARC BLOOD TYPING, ABO", "code_information": [ { "code": "86900", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 205.0, "discounted_cash": 141.0, "minimum": 3.0, "maximum": 205.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 170.24, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4.57 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 141.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 148.96, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 134.78, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 141.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 141.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 191.52, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 198.62, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 205.0, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 141.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 141.87, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "fee schedule", "standard_charge_dollar": 141.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 205.0, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 48.82 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 141.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 163.15, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Medicare", "methodology": "fee schedule", "standard_charge_dollar": 141.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 41.11 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 141.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 156.06, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 141.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4.34 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 141.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 148.96, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 148.96, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 205.0, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 146.13, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 146.13, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "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": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Commercial", "methodology": "fee schedule", "standard_charge_dollar": 141.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 141.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 141.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 141.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 141.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 141.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3.59 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 177.34, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 141.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 141.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 141.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 48.82 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 146.13, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY OF ASCORBIC ACID", "code_information": [ { "code": "82180", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 53.0, "discounted_cash": 9.0, "minimum": 3.8, "maximum": 42.4, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 11.87, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.13 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 10.38, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 9.4, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 9.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 9.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 13.35, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 13.85, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.02, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.93, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "fee schedule", "standard_charge_dollar": 9.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 15.33, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.37, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 10.88, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.34 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 10.38, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.99 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.38, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.84, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.99 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.19, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 10.19, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.38, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 9.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 9.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.87 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.36, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 9.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.19, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY OF VITAMIN A", "code_information": [ { "code": "84590", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 243.0, "discounted_cash": 11.0, "minimum": 6.966, "maximum": 194.4, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 13.93, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.76 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 12.19, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.41 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 11.03, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.41 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 11.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 11.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 15.67, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 16.25, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.81, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.97, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "fee schedule", "standard_charge_dollar": 11.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 18.0, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.41 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 91.55 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.35, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 77.1 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.41 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 12.77, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.83 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 12.19, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.83 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.19, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.42, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.83 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.96, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 11.96, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "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": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 11.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.41 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.93 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.51, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 11.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 91.55 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.96, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "HC ARTERIAL LINE INSERTION", "code_information": [ { "code": "36620", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 738.0, "minimum": 44.47, "maximum": 738.0, "payers_information": [ { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 592.98 }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 738.0 }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 592.98 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 592.98 }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 738.0 }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 592.98 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 592.98 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 622.63 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 622.63 }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Commercial", "methodology": "fee schedule", "standard_charge_dollar": 44.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 44.47 }, { "payer_name": "Standard EAPG Logic - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 592.68 } ] } ] }, { "description": "HC ASSAY GROWTH HORMONE (HGH)", "code_information": [ { "code": "83003", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 110.0, "discounted_cash": 16.0, "minimum": 9.28, "maximum": 110.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 20.0, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 25.51 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 17.5, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.28 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 15.84, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.28 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 16.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 16.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 22.5, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 23.34, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 27.01, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.0, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "fee schedule", "standard_charge_dollar": 16.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 25.84, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.28 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 110.0 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.17, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 110.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.28 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 18.34, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 24.17 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 17.5, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.74 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.5, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 25.01, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.74 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.17, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 17.17, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.5, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 16.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.28 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.0 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 20.84, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 16.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 110.0 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.17, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY OF BLOOD OSMOLALITY", "code_information": [ { "code": "83930", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 56.0, "discounted_cash": 6.0, "minimum": 3.8, "maximum": 56.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 7.93, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10.11 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 6.94, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 6.28, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 6.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 6.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 8.92, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 9.25, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.71, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.97, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "fee schedule", "standard_charge_dollar": 6.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 10.25, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 56.0 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.6, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 56.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 7.27, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.58 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 6.94, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.99 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.94, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9.92, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.99 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.81, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 6.81, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "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": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 6.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.93 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.26, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 6.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 56.0 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.81, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY OF VITAMIN B-1", "code_information": [ { "code": "84425", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 78.0, "discounted_cash": 21.0, "minimum": 8.41, "maximum": 78.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 25.48, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 32.48 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 22.29, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.41 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 20.17, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.41 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 21.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 21.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 28.66, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 29.72, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 34.39, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.74, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "fee schedule", "standard_charge_dollar": 21.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 32.91, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.41 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 78.0 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 24.41, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 78.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.41 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 23.35, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 30.78 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 22.29, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.83 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.29, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 31.85, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.83 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.87, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 21.87, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.29, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 25.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 21.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.41 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 21.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 25.48 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 26.54, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 21.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 78.0 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.87, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "HC ASP/DRAIN LARGE JOINT/BURSA", "code_information": [ { "code": "20610", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1424.0, "discounted_cash": 327.0, "minimum": 45.6, "maximum": 1424.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 392.78, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 762.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 327.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 343.69, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 213.48 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 310.95, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 213.48 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 327.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 327.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 441.88, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 458.25, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 530.26, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 327.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 1424.0 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 327.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "fee schedule", "standard_charge_dollar": 327.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 507.35, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 213.48 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 327.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 376.42, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Medicare", "methodology": "fee schedule", "standard_charge_dollar": 327.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 213.48 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 327.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 360.05, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 327.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 327.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 343.69, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 224.15 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 343.69, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 490.98, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 224.15 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 337.14, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 337.14, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 343.69, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Commercial", "methodology": "fee schedule", "standard_charge_dollar": 45.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 327.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 45.6 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 327.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 327.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 213.37 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 213.48 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 327.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 327.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 409.15, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 327.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 327.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 327.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 337.14, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY OF CALCIUM, IONIZED", "code_information": [ { "code": "82330", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 119.0, "discounted_cash": 13.0, "minimum": 8.208, "maximum": 119.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 16.42, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.93 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 14.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.41 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 13.0, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.41 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 13.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 13.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 18.47, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 19.15, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 22.16, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.21, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "fee schedule", "standard_charge_dollar": 13.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 21.2, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.41 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 119.0 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.73, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 108.34 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.41 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.84 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 14.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.83 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.36, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 20.52, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.83 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.09, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 14.09, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "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": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 13.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.41 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.42 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.1, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 13.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 119.0 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.09, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY OF CALCIUM IN URINE", "code_information": [ { "code": "82340", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 53.0, "discounted_cash": 6.0, "minimum": 3.618, "maximum": 53.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 7.24, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.23 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 6.33, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 5.73, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 6.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 6.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 8.14, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 8.44, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9.77, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.62, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "fee schedule", "standard_charge_dollar": 6.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 9.35, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 53.0 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.93, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 53.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 6.63, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.74 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 6.33, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.99 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.33, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9.05, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.99 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.21, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 6.21, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.33, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 6.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.24 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.54, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 6.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 53.0 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.21, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY UREA NITROGEN, QUAN", "code_information": [ { "code": "84520", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 33.0, "discounted_cash": 3.0, "minimum": 2.37, "maximum": 33.0, "payers_information": [ { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5.93, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.99 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.07, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 4.07, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4.74 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4.94, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 3.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 33.0 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.07, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 4.74, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.04 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 4.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3.75, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 3.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 3.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 5.33, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 5.53, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.4, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.37, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "fee schedule", "standard_charge_dollar": 3.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 6.12, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 33.0 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4.54, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 33.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 4.35, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.73 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 4.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.99 } ] } ] }, { "description": "HC ASSAY FOR CALPROTECTIN FECAL", "code_information": [ { "code": "83993", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 372.0, "discounted_cash": 19.0, "minimum": 8.41, "maximum": 297.6, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 23.56, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 30.03 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 20.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.41 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 18.65, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.41 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 19.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 19.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 26.5, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 27.48, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 31.8, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 69.0, "median_amount": 256.68, "10th_percentile": 256.68, "90th_percentile": 256.68, "count": "1 through 10" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.78, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "fee schedule", "standard_charge_dollar": 19.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 30.43, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.41 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 22.57, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.41 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 21.59, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 28.46 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 20.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.83 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 29.45, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.83 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.22, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 20.22, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "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": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 23.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 19.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.41 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 19.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 23.56 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 24.54, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 19.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.22, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY OF CALCIUM, TOTAL", "code_information": [ { "code": "82310", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 45.0, "discounted_cash": 5.0, "minimum": 3.096, "maximum": 45.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 6.19, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.89 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 5.42, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 4.9, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 5.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 5.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 6.97, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 7.22, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.36, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.1, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "fee schedule", "standard_charge_dollar": 5.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 8.0, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 45.0 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.93, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 45.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 5.68, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.48 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 5.42, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.99 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.42, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.74, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.99 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.31, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 5.31, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "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": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 5.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.19 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.45, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 5.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 45.0 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.31, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY OF CAROTENE", "code_information": [ { "code": "82380", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 59.0, "discounted_cash": 9.0, "minimum": 3.8, "maximum": 47.2, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 11.06, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.11 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 9.68, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 8.76, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 9.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 9.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 12.45, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 12.91, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.94, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.53, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "fee schedule", "standard_charge_dollar": 9.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 14.29, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10.6, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 10.14, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.37 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 9.68, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.99 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.68, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 13.83, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.99 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.5, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 9.5, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.68, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 9.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 9.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.06 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 9.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.5, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY VIT D, 1,25-DIHYDROXY W FRACTIONS", "code_information": [ { "code": "82652", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 192.0, "discounted_cash": 38.0, "minimum": 19.8, "maximum": 192.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 46.2, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 58.91 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 40.43, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.8 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 36.58, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.8 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 38.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 38.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 51.98, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 53.9, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 62.37, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.1, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "fee schedule", "standard_charge_dollar": 38.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 59.68, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.8 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 192.0 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 44.28, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 174.69 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.8 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 42.35, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 55.83 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 40.43, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.79 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.43, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 57.75, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.79 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 39.66, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 39.66, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.43, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Commercial", "methodology": "fee schedule", "standard_charge_dollar": 38.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 45.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 38.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.8 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 38.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 46.2 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 48.13, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 38.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 192.0 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 39.66, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY OF ALDOLASE", "code_information": [ { "code": "82085", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 84.0, "discounted_cash": 9.0, "minimum": 3.8, "maximum": 84.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 11.65, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.86 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 10.2, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 9.22, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 9.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 9.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 13.11, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 13.59, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15.73, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.83, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "fee schedule", "standard_charge_dollar": 9.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 84.0 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.17, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 84.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 10.68, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.08 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 10.2, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.99 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.2, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.99 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.0, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 10.0, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "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": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 9.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 9.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.65 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.14, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 9.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 84.0 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.0, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY OF CPK IN BLOOD", "code_information": [ { "code": "82552", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 106.0, "discounted_cash": 13.0, "minimum": 8.034, "maximum": 106.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 16.07, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.49 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 14.06, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.41 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 12.72, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.41 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 13.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 13.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 18.08, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 18.75, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.69, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.03, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "fee schedule", "standard_charge_dollar": 13.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 20.75, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.41 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 106.0 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.4, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 106.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.41 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 14.73, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.42 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 14.06, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.83 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.06, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 20.09, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.83 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.79, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 13.79, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.06, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 13.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.41 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.07 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.74, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 13.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 106.0 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.79, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY OF COPPER", "code_information": [ { "code": "82525", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 128.0, "discounted_cash": 12.0, "minimum": 7.446, "maximum": 128.0, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 16.75, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 17.37, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 20.1, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.45, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "fee schedule", "standard_charge_dollar": 12.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 19.24, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.66 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 128.0 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.27, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 124.49 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.66 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 13.65, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.99 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 13.03, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.09 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.03, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.62, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.09 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.78, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 12.78, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "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": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 12.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.66 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.89 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15.51, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 12.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 128.0 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.78, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 14.89, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.99 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 13.03, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.66 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 11.79, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.66 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 12.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 12.41, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY, TOXIN OR ANTITOXIN", "code_information": [ { "code": "87230", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 136.0, "discounted_cash": 19.0, "minimum": 7.41, "maximum": 136.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 23.69, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 30.2 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 20.73, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.41 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 18.75, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.41 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 19.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 19.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 26.65, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 27.64, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 31.98, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.84, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "fee schedule", "standard_charge_dollar": 19.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 30.6, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.41 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 136.0 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 22.7, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 127.97 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.41 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 21.71, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 28.62 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 20.73, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.78 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.73, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 29.61, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.78 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.33, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 20.33, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.73, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 23.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 19.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.41 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 19.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 23.69 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 24.68, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 19.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 136.0 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.33, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY OF AMMONIA", "code_information": [ { "code": "82140", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 135.0, "discounted_cash": 14.0, "minimum": 8.41, "maximum": 117.88, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 17.48, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 22.29 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 15.3, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.41 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 13.84, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.41 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 19.67, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 20.4, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 23.6, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.74, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 22.58, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.41 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 117.88 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.76, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 99.26 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.41 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 16.03, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.13 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 15.3, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.83 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.3, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.86, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.83 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.01, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 15.01, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "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": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.41 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.48 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.21, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 117.88 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.01, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY OF CREATININE", "code_information": [ { "code": "82565", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 42.0, "discounted_cash": 5.0, "minimum": 3.072, "maximum": 42.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 6.14, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.83 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 5.38, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 4.86, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 5.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 5.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 6.91, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 7.17, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.29, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.07, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "fee schedule", "standard_charge_dollar": 5.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 7.94, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 42.0 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.89, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 42.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 5.63, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.42 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 5.38, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.99 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.38, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.68, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.99 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.27, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 5.27, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.38, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 5.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.14 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.4, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 5.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 42.0 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.27, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY OF DIGOXIN", "code_information": [ { "code": "80162", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 151.0, "discounted_cash": 13.0, "minimum": 7.968, "maximum": 131.05, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 15.94, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.32 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 13.94, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.53 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 12.62, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.53 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 13.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 13.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 18.59, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.51, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.97, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "fee schedule", "standard_charge_dollar": 13.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 20.58, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.53 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 131.05 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.27, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 110.36 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.53 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 14.61, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.26 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 13.94, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.96 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.94, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.92, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.96 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.68, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 13.68, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.94, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 13.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.53 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.94 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.6, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 13.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 131.05 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.68, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "HC BASIC METABOLIC PANEL CALCIUM IONIZED", "code_information": [ { "code": "80047", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 128.0, "discounted_cash": 13.0, "minimum": 6.35, "maximum": 102.4, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 16.48, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.01 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 14.42, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.35 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 13.04, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.35 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 13.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 13.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 18.54, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 19.22, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 22.24, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.24, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "fee schedule", "standard_charge_dollar": 13.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 21.28, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.35 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.79, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.35 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 15.1, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.91 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 14.42, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.67 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.42, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 20.6, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.67 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.14, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 14.14, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.42, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 13.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.35 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.48 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.16, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 13.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.14, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY OF AMYLASE", "code_information": [ { "code": "82150", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 225.0, "discounted_cash": 6.0, "minimum": 3.8, "maximum": 180.0, "payers_information": [ { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.78 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.1, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 101.69 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.67, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 7.78, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.91 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 6.8, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 6.16, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 8.75, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 9.07, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.5, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.89, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 10.04, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 101.69 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.45, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 85.63 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 7.13, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.4 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 6.8, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.99 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.8, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9.72, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.99 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.67, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 6.67, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.8, "additional_payer_notes": "105.00% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY OF CYCLOSPORINE", "code_information": [ { "code": "80158", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 148.0, "discounted_cash": 18.0, "minimum": 8.53, "maximum": 148.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 21.66, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 27.62 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 18.95, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.53 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 17.15, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.53 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 18.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 18.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 24.37, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 25.27, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 29.24, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.83, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "fee schedule", "standard_charge_dollar": 18.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 27.98, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.53 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 148.0 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.76, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 136.99 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.53 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 19.86, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 26.17 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 18.95, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.96 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.95, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 27.08, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.96 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.59, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 18.59, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.95, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 18.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.53 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.66 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 22.56, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 18.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 148.0 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.59, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY OF ESTRIOL", "code_information": [ { "code": "82677", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 28.0, "discounted_cash": 24.0, "minimum": 7.364, "maximum": 28.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 28.0, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 28.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 25.39, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.28 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 22.97, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.28 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 24.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 24.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 28.0, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 28.0, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 28.0, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.51, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "fee schedule", "standard_charge_dollar": 24.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 28.0, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.28 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 28.0 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 27.81, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 28.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.28 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 26.6, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 28.0 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 25.39, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.74 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.39, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 28.0, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.74 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.91, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 24.91, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "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": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Commercial", "methodology": "fee schedule", "standard_charge_dollar": 24.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 24.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.28 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 24.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 28.0 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 28.0, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 24.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 28.0 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.91, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "HC BCR/ABL1 GENE MAJOR BP", "code_information": [ { "code": "81206", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1341.0, "discounted_cash": 163.0, "minimum": 98.376, "maximum": 1072.8, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 196.75, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 250.86 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 163.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 172.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 115.83 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 155.76, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 115.83 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 163.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 163.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 221.35, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 229.54, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 265.62, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 163.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 98.38, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "fee schedule", "standard_charge_dollar": 163.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 254.14, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 115.83 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 163.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 188.55, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Medicare", "methodology": "fee schedule", "standard_charge_dollar": 163.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 115.83 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 163.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 180.36, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 163.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 237.74 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 163.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 172.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 121.62 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 172.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 245.94, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 121.62 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 168.88, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 168.88, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 172.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Commercial", "methodology": "fee schedule", "standard_charge_dollar": 163.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 163.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 163.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 163.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 115.83 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 163.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 163.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 196.75 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 204.95, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 163.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 163.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 163.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 168.88, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY OF BLOOD LIPOPROTEIN,HDL CHOLEST", "code_information": [ { "code": "83718", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 72.0, "discounted_cash": 8.0, "minimum": 3.8, "maximum": 72.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 9.83, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.53 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 8.6, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 7.78, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 8.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 8.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 11.06, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 11.47, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 13.27, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.91, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "fee schedule", "standard_charge_dollar": 8.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 12.69, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 72.0 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.42, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 63.98 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 9.01, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.88 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 8.6, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.99 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.6, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.29, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.99 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.44, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 8.44, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.6, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 8.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.83 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.24, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 8.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 72.0 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.44, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY OF ERYTHROPOIETIN", "code_information": [ { "code": "82668", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 341.0, "discounted_cash": 18.0, "minimum": 8.41, "maximum": 272.8, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 22.55, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 28.75 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 19.73, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.41 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 17.85, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.41 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 18.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 18.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 25.37, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 26.31, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 30.44, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.27, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "fee schedule", "standard_charge_dollar": 18.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 29.12, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.41 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 233.32 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.61, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 196.48 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.41 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 20.67, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 27.25 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 19.73, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.83 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.73, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 28.19, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.83 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.35, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 19.35, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.73, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 22.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 18.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.41 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 22.55 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 23.49, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 18.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 233.32 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.35, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY OF ETHANOL - 80320 - 30100052", "code_information": [ { "code": "80320", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 258.0, "minimum": 1.0, "maximum": 206.4, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1.0 }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.84 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.84 }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.84 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.84 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.33 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 10.33 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.0 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.84 }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 12.21, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC BETA-AMYLOID 1-42 (ABETA 42)", "code_information": [ { "code": "82234", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 698.0, "discounted_cash": 128.0, "minimum": 77.352, "maximum": 558.4, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 154.7, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 128.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 135.37, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 115.83 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 122.47, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 115.83 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 128.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 128.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 174.04, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 180.49, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 208.85, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 128.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 77.35, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "fee schedule", "standard_charge_dollar": 128.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 199.83, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 115.83 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 128.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 148.26, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Medicare", "methodology": "fee schedule", "standard_charge_dollar": 128.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 115.83 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 128.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 141.81, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 128.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 186.93 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 128.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 135.37, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 121.62 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 135.37, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 193.38, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 121.62 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 132.79, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 132.79, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 135.37, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Commercial", "methodology": "fee schedule", "standard_charge_dollar": 128.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 128.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 128.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 128.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 115.83 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 128.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 128.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 161.15, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 128.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 128.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 128.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 132.79, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY OF BLOOD LIPOPROTEIN,LDL CHOLEST", "code_information": [ { "code": "83721", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 62.0, "discounted_cash": 10.0, "minimum": 3.8, "maximum": 49.6, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 14.7, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.01, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.3, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "fee schedule", "standard_charge_dollar": 10.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 16.28, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 41.95 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.08, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 35.33 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 11.55, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.23 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 11.03, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.99 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.03, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15.75, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.99 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.82, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 10.82, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.03, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 10.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 10.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.6 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 13.13, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 10.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 41.95 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.82, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 12.6, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.07 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 11.03, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 9.98, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 10.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 10.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 14.18, "additional_payer_notes": "135.00% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY OF G6PD ENZYME", "code_information": [ { "code": "82955", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 67.0, "discounted_cash": 9.0, "minimum": 3.8, "maximum": 67.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 11.64, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.84 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 10.19, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 9.22, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 9.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 9.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 13.1, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 13.58, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15.71, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.82, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "fee schedule", "standard_charge_dollar": 9.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 15.04, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 67.0 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 67.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 10.67, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.07 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 10.19, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.99 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.19, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.55, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.99 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.99, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 9.99, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "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": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 9.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 9.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.64 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.13, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 9.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 67.0 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.99, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY OF ETHANOL - G0480 - 30100052", "code_information": [ { "code": "G0480", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 258.0, "discounted_cash": 114.0, "minimum": 49.07, "maximum": 206.4, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 137.32, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 175.08 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 120.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 49.07 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 108.71, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 49.07 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 154.48, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 160.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 185.38, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 68.66, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 177.37, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 49.07 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 131.59, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 49.07 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 125.87, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 165.92 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 120.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 51.52 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 120.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 171.65, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 51.52 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 117.86, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 117.86, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "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": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Commercial", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 49.07 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 137.32 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 143.04, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 117.86, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "HC BLD CLOT FACTOR VIII, VW FC ANTIGEN", "code_information": [ { "code": "85246", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 255.0, "discounted_cash": 22.0, "minimum": 13.764, "maximum": 204.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 27.53, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 35.1 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 24.09, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.81 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 21.79, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.81 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 22.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 22.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 30.97, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 32.12, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 37.16, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.76, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "fee schedule", "standard_charge_dollar": 22.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 35.56, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.81 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 170.28 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 26.38, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 143.39 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.81 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 25.23, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 33.26 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 24.09, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.7 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.09, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 34.41, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.7 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.63, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 23.63, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.09, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Commercial", "methodology": "fee schedule", "standard_charge_dollar": 22.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 22.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.81 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 22.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 27.53 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 28.68, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 22.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 170.28 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.63, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY OF C-PEPTIDE", "code_information": [ { "code": "84681", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 94.0, "discounted_cash": 20.0, "minimum": 8.41, "maximum": 94.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 24.97, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 31.84 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 21.85, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.41 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 19.77, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.41 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 28.09, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 29.13, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 33.71, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.49, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 32.26, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.41 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 94.0 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 23.93, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 94.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.41 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 22.89, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 30.17 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 21.85, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.83 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.85, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 31.22, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.83 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.43, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 21.43, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "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": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 24.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.41 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 24.97 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 26.01, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 94.0 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.43, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY OF GGT", "code_information": [ { "code": "82977", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 168.0, "discounted_cash": 7.0, "minimum": 3.8, "maximum": 134.4, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 8.64, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.02 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 7.56, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 6.84, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 7.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 7.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 9.72, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 10.08, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11.66, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.32, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "fee schedule", "standard_charge_dollar": 7.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 61.58 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.28, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 51.86 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 7.92, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10.44 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 7.56, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.99 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.56, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.8, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.99 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.42, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 7.42, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.56, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 7.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.64 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9.0, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 7.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 61.58 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.42, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY OF INSULIN,TOTAL", "code_information": [ { "code": "83525", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 90.0, "discounted_cash": 11.0, "minimum": 6.858, "maximum": 90.0, "payers_information": [ { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 11.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.28 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.72 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.29, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 11.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 90.0 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.77, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 13.72, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.49 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 12.0, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.28 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 10.86, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.28 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 11.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 11.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 15.43, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 16.0, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.52, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.86, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "fee schedule", "standard_charge_dollar": 11.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 17.72, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.28 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 90.0 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.14, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 90.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.28 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 12.57, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.57 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 12.0, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.74 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.0, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.15, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.74 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.77, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 11.77, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.0, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.43, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC BLOOD GASES: PH, PO2 & PCO2 W O2 SATU", "code_information": [ { "code": "82805", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 182.0, "discounted_cash": 78.0, "minimum": 37.0, "maximum": 182.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 94.52, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 120.52 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 78.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 82.71, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 47.89 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 74.83, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 47.89 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 78.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 78.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 106.34, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 110.28, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 127.61, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 78.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 47.26, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "fee schedule", "standard_charge_dollar": 78.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 122.09, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 47.89 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 182.0 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 78.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 90.59, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Medicare", "methodology": "fee schedule", "standard_charge_dollar": 78.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 182.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 47.89 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 78.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 86.65, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 78.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 114.22 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 78.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 82.71, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 50.28 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 82.71, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 118.16, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 50.28 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 81.13, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 81.13, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 82.71, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Commercial", "methodology": "fee schedule", "standard_charge_dollar": 78.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 78.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 37.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 78.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 78.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 47.89 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 78.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 78.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 94.52 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 98.46, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 78.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 78.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 78.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 182.0 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 81.13, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY OF CARBAMAZEPINE TOTAL", "code_information": [ { "code": "80156", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 216.0, "discounted_cash": 14.0, "minimum": 8.53, "maximum": 177.27, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 17.48, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 22.29 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 15.3, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.53 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 13.84, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.53 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 19.67, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 20.4, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 23.6, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.74, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 22.58, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.53 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 177.27 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.76, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 149.28 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.53 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 16.03, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.13 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 15.3, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.96 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.3, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.86, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.96 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.01, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 15.01, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "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": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.53 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.48 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.21, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 177.27 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.01, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY OF LACTIC ACID", "code_information": [ { "code": "83605", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 82.0, "discounted_cash": 11.0, "minimum": 6.942, "maximum": 82.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 13.88, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.7 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 12.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.41 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 10.99, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.41 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 11.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 11.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 15.62, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 16.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.74, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.94, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "fee schedule", "standard_charge_dollar": 11.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.41 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 82.0 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.31, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 82.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.41 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 12.73, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.78 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 12.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.83 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.36, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.83 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.92, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 11.92, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.15, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 11.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.41 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.88 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 11.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 82.0 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.92, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY OF IRON", "code_information": [ { "code": "83540", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 79.0, "discounted_cash": 6.0, "minimum": 3.8, "maximum": 77.37, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 7.76, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.9 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 6.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 6.15, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 8.73, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 9.06, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.48, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.88, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 10.03, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 77.37 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.44, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 65.15 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 7.12, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.38 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 6.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.99 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9.71, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.99 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.66, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 6.66, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.76 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.09, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 77.37 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.66, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "HC BLOOD PLATELET AGGREGATION", "code_information": [ { "code": "85576", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 185.0, "discounted_cash": 24.0, "minimum": 14.946, "maximum": 148.68, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 29.89, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 38.11 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 26.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.81 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 23.66, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.81 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 24.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 24.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 33.63, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 34.87, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.35, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.95, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "fee schedule", "standard_charge_dollar": 24.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 38.61, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.81 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 148.68 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 28.65, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 125.2 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.81 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 27.4, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 36.12 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 26.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.7 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 37.37, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 18.7 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.66, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 25.66, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Commercial", "methodology": "fee schedule", "standard_charge_dollar": 24.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 25.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 24.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 17.81 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 24.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 29.89 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 31.14, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 24.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 148.68 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.66, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY OF CITRATE", "code_information": [ { "code": "82507", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 326.0, "discounted_cash": 27.0, "minimum": 15.0, "maximum": 260.8, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 33.36, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 42.53 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 29.19, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.8 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 26.41, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.8 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 27.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 27.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 37.53, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 38.92, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 45.04, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.68, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "fee schedule", "standard_charge_dollar": 27.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 43.09, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.8 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 120.93 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 31.97, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 101.83 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.8 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 30.58, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 40.31 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 29.19, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.79 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.19, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 41.7, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.79 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.63, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 28.63, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.19, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Commercial", "methodology": "fee schedule", "standard_charge_dollar": 27.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 27.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.8 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 27.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 33.36 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 34.75, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 27.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 120.93 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.63, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY OF LEAD", "code_information": [ { "code": "83655", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 78.0, "discounted_cash": 12.0, "minimum": 7.266, "maximum": 78.0, "payers_information": [ { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.27, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 18.77, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.66 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 78.0 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.93, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 74.71 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.66 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 13.32, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.56 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 12.72, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.09 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.72, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.17, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.09 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.47, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 12.47, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "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": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.66 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.53 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15.14, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 78.0 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.47, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 14.53, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.53 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 12.72, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.66 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 11.5, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.66 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 16.35, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 16.95, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.62, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 69.0, "median_amount": 53.82, "10th_percentile": 53.82, "90th_percentile": 53.82, "count": "1 through 10" } ] } ] }, { "description": "HC ASSAY OF PROGESTERONE", "code_information": [ { "code": "84144", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 514.0, "discounted_cash": 20.0, "minimum": 9.28, "maximum": 411.2, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 25.03, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 31.92 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 21.9, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.28 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 19.82, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.28 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 20.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 20.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 28.16, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 29.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 33.79, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.52, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "fee schedule", "standard_charge_dollar": 20.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 32.33, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.28 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 149.82 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 23.99, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 126.16 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.28 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 22.95, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 30.25 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 21.9, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.74 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.9, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 31.29, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.74 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.49, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 21.49, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.9, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 24.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 20.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.28 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 20.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 25.03 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 26.08, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 20.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 149.82 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.49, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "HC BLOOD TYPE ANTIGEN DONOR REAGENT SERUM, EA AG", "code_information": [ { "code": "86902", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 419.0, "discounted_cash": 382.0, "minimum": 3.11, "maximum": 419.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 419.0, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.72 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 382.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 401.34, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.11 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 363.12, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.11 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 382.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 382.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 419.0, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 419.0, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 419.0, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 382.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 382.23, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "fee schedule", "standard_charge_dollar": 382.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 419.0, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.11 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 382.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 419.0, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Medicare", "methodology": "fee schedule", "standard_charge_dollar": 382.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.11 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 382.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 419.0, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 382.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.21 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 382.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 401.34, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.27 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.34, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 419.0, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.27 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 393.7, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 393.7, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 401.34, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Commercial", "methodology": "fee schedule", "standard_charge_dollar": 382.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 382.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 382.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 382.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.11 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 382.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 382.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.62 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 419.0, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 382.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 382.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 382.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 393.7, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY OF CORTICOSTEROIDS", "code_information": [ { "code": "83491", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 114.0, "discounted_cash": 17.0, "minimum": 9.28, "maximum": 91.2, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 21.48, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 27.39 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 18.8, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.28 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 17.01, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.28 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 17.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 17.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 24.17, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 25.06, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 29.0, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "fee schedule", "standard_charge_dollar": 17.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 27.75, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.28 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.59, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.28 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 19.69, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 25.96 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 18.8, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.74 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.8, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 26.85, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.74 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.44, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 18.44, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "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": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 17.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.28 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 17.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.48 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 22.38, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 17.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.44, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY OF MAGNESIUM", "code_information": [ { "code": "83735", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 187.0, "discounted_cash": 6.0, "minimum": 3.8, "maximum": 149.6, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 8.04, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10.25 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 7.04, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 6.37, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 6.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 6.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 9.05, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 9.38, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.85, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 69.0, "median_amount": 7.36, "10th_percentile": 7.36, "90th_percentile": 129.03, "count": "1 through 10" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.02, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "fee schedule", "standard_charge_dollar": 6.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 10.39, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 76.29 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.71, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 64.25 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 7.37, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.72 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 7.04, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.99 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.04, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.05, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.99 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.9, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 6.9, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.04, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 6.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.04 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.38, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 6.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 76.29 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.9, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY OF PYRUVATE KINASE", "code_information": [ { "code": "84220", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 108.0, "discounted_cash": 9.0, "minimum": 3.8, "maximum": 86.4, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 11.33, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.44 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 9.91, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 8.97, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 9.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 9.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 12.74, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 13.22, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15.29, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.66, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "fee schedule", "standard_charge_dollar": 9.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 14.63, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10.86, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 10.38, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.69 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 9.91, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.99 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.91, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.16, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.99 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.72, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 9.72, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "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": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 9.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 9.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.33 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11.8, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 9.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.72, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "HC BONE BIOPSY,TROCAR/NEEDLE DEEP", "code_information": [ { "code": "20225", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3696.0, "discounted_cash": 1761.0, "minimum": 125.16, "maximum": 3696.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 2113.45, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1020.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 1849.27, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1551.83 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 1673.15, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1551.83 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 2377.63, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 2465.69, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2853.16, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 3696.0 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 2729.88, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1551.83 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2025.39, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1551.83 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 1937.33, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 1500.0 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 1849.27, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1629.42 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1849.27, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2641.82, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1629.42 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1814.05, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 1814.05, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1849.27, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Commercial", "methodology": "fee schedule", "standard_charge_dollar": 125.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 125.16 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1551.83 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2201.51, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1814.05, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY OF ESTROGENS", "code_information": [ { "code": "82671", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 255.0, "discounted_cash": 32.0, "minimum": 19.38, "maximum": 204.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 38.76, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 49.42 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 32.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 33.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.6 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 30.69, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.6 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 32.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 32.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 43.61, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 45.22, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 52.33, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 32.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.38, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "fee schedule", "standard_charge_dollar": 32.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 50.07, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.6 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 32.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 37.15, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Medicare", "methodology": "fee schedule", "standard_charge_dollar": 32.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.6 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 32.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 35.53, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 32.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 46.84 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 32.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 33.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.83 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 33.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 48.45, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.83 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 33.27, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 33.27, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 33.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Commercial", "methodology": "fee schedule", "standard_charge_dollar": 32.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 32.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 30.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 32.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 32.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.6 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 32.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 32.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 38.76 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.38, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 32.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 32.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 32.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 33.27, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY OF PHENYTOIN, FREE", "code_information": [ { "code": "80186", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 119.0, "discounted_cash": 13.0, "minimum": 8.256, "maximum": 119.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 16.51, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.05 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 14.45, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.53 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 13.07, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.53 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 13.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 13.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 18.58, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 19.26, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 22.29, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.26, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "fee schedule", "standard_charge_dollar": 13.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 21.33, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.53 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 119.0 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.82, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 116.9 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.53 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 15.14, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.95 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 14.45, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.96 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.45, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 20.64, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.96 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.17, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 14.17, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "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": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 13.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.53 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.51 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.2, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 13.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 119.0 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.17, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY OF RENIN", "code_information": [ { "code": "84244", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 115.0, "discounted_cash": 21.0, "minimum": 9.28, "maximum": 115.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 26.39, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 33.64 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 23.09, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.28 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 20.89, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.28 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 21.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 21.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 29.69, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 30.79, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 35.62, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.19, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "fee schedule", "standard_charge_dollar": 21.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 34.08, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.28 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 115.0 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 25.29, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 115.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.28 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 24.19, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 31.89 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 23.09, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.74 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.09, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 32.99, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.74 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.65, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 22.65, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "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": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 26.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 21.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.28 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 21.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 26.39 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 27.49, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 21.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 115.0 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.65, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "HC BRONCHOSCOPY DIAG W LAVAGE", "code_information": [ { "code": "31624", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2384.0, "discounted_cash": 1898.0, "minimum": 132.03, "maximum": 2384.0, "payers_information": [ { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 1898.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 2384.0, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 2384.0, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2384.0, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1898.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 2384.0 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1898.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "fee schedule", "standard_charge_dollar": 1898.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 2384.0, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1554.13 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1898.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2182.72, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1898.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1554.13 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1898.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 2087.82, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1898.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 1500.0 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1898.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 1992.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1631.84 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1992.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2384.0, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1631.84 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1954.96, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 1954.96, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1992.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Commercial", "methodology": "fee schedule", "standard_charge_dollar": 132.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1898.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 132.03 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1898.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1898.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 1553.35 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1554.13 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1898.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1898.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2372.53, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1898.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 1898.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1898.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1954.96, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 2277.62, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1020.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1898.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 1992.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1554.13 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 1803.12, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1554.13 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 1898.02, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY OF FOLIC ACID, RBC", "code_information": [ { "code": "82747", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 148.0, "discounted_cash": 17.0, "minimum": 8.41, "maximum": 148.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 21.18, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 27.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 18.53, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.41 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.41 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 17.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 17.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 23.83, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 24.71, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 28.59, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.59, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "fee schedule", "standard_charge_dollar": 17.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 27.36, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.41 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 148.0 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.3, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 148.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.41 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 19.42, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 25.59 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 18.53, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.83 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.53, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 26.48, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.83 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.18, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 18.18, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "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": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 17.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.41 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 17.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.18 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 22.06, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 17.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 148.0 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.18, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY OF PHENYTOIN, TOTAL", "code_information": [ { "code": "80185", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 102.0, "discounted_cash": 13.0, "minimum": 7.95, "maximum": 102.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 15.9, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.27 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 13.91, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.53 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 12.59, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.53 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 17.89, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 18.55, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.47, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.95, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 20.54, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.53 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 102.0 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.24, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 102.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.53 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 14.58, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.21 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 13.91, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.96 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.91, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.88, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.96 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.65, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 13.65, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "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": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.53 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.9 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.56, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 102.0 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.65, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY OF SERUM POTASSIUM", "code_information": [ { "code": "84132", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 42.0, "discounted_cash": 4.0, "minimum": 2.856, "maximum": 42.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 5.71, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.28 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 5.0, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 4.52, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 4.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 4.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 6.43, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 6.66, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.71, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.86, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "fee schedule", "standard_charge_dollar": 4.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 7.38, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 42.0 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.47, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 37.3 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 5.24, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.9 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 5.0, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.99 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.0, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.14, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.99 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.9, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 4.9, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.0, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 4.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.71 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5.95, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 4.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 42.0 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.9, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "HC BRONCHOSCOPY DIAG W LUNG BX, SINGLE LOBE", "code_information": [ { "code": "31628", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5079.0, "discounted_cash": 3975.0, "minimum": 173.9, "maximum": 5079.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 4770.94, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1020.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3975.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 4174.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1554.13 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3776.99, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1554.13 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 3975.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 3975.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 5079.0, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 5079.0, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5079.0, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3975.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3975.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "fee schedule", "standard_charge_dollar": 3975.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 5079.0, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1554.13 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3975.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4572.15, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3975.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1554.13 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3975.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 4373.36, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3975.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 1500.0 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3975.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 4174.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1631.84 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4174.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5079.0, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1631.84 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4095.05, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 4095.05, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4174.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Commercial", "methodology": "fee schedule", "standard_charge_dollar": 173.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3975.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 173.9 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3975.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3975.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 1553.35 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1554.13 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3975.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3975.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4969.73, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3975.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 3975.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3975.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4095.05, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY OF FREE THYROXINE", "code_information": [ { "code": "84439", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 106.0, "discounted_cash": 9.0, "minimum": 5.412, "maximum": 106.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 10.82, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.8 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 9.47, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.28 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 8.57, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.28 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 9.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 9.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 12.18, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 12.63, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.61, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 69.0, "median_amount": 73.14, "10th_percentile": 10.3, "90th_percentile": 73.14, "count": "1 through 10" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.41, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "fee schedule", "standard_charge_dollar": 9.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 13.98, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.28 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 106.0 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10.37, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 106.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.28 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 9.92, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.08 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 9.47, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.74 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.47, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 13.53, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.74 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.29, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 9.29, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.47, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 9.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.28 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 9.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10.82 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11.28, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 9.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 106.0 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.29, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY OF PREALBUMIN", "code_information": [ { "code": "84134", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 90.0, "discounted_cash": 14.0, "minimum": 8.41, "maximum": 90.0, "payers_information": [ { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 15.03, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "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": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 14.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.41 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.51 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.24, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 14.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 90.0 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.03, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 17.51, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 22.32 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.41 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 13.86, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.41 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 14.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 14.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 19.7, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 20.43, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 23.64, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.75, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "fee schedule", "standard_charge_dollar": 14.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 22.61, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.41 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 90.0 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.78, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 78.06 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.41 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 16.05, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.16 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.83 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.89, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.83 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.03, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY OF SERUM SODIUM", "code_information": [ { "code": "84295", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 44.0, "discounted_cash": 4.0, "minimum": 2.886, "maximum": 38.26, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 5.77, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.36 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 5.05, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 4.57, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 4.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 4.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 6.49, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 6.73, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.79, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.89, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "fee schedule", "standard_charge_dollar": 4.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 7.46, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 38.26 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.53, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 32.22 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 5.29, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.97 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 5.05, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.99 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.05, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.22, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.99 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.95, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 4.95, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.05, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 4.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.77 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.01, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 4.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 38.26 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.95, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "HC BRONCHOSCOPY DIAG W NEEDLE ASP BX, SINGLE LOBE", "code_information": [ { "code": "31629", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5079.0, "discounted_cash": 3975.0, "minimum": 184.94, "maximum": 5079.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 4770.94, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1020.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3975.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 4174.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1554.13 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3776.99, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1554.13 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 3975.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 3975.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 5079.0, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 5079.0, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5079.0, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3975.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3975.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "fee schedule", "standard_charge_dollar": 3975.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 5079.0, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1554.13 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3975.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4572.15, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3975.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1554.13 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3975.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 4373.36, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3975.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 1500.0 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3975.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 4174.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1631.84 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4174.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5079.0, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1631.84 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4095.05, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 4095.05, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4174.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Commercial", "methodology": "fee schedule", "standard_charge_dollar": 184.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3975.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 184.94 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3975.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3975.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 1553.35 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1554.13 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3975.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3975.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4969.73, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3975.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 3975.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3975.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4095.05, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY OF GAMMAGLOBULIN IGA, IGD, IGG, IGM, EACH", "code_information": [ { "code": "82784", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 140.0, "discounted_cash": 9.0, "minimum": 3.8, "maximum": 112.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.23 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 9.77, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 8.84, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 9.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 9.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 12.56, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 13.02, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15.07, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.58, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "fee schedule", "standard_charge_dollar": 9.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 14.42, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 107.95 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10.7, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 90.9 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 10.23, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.49 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 9.77, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.99 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.77, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 13.95, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.99 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.58, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 9.58, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "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": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 9.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 9.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.16 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11.63, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 9.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 107.95 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.58, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY OF PROCALCITONIN", "code_information": [ { "code": "84145", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 170.0, "discounted_cash": 27.0, "minimum": 9.28, "maximum": 136.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 32.66, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 41.65 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 28.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.28 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 25.86, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.28 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 27.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 27.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 36.75, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 38.11, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 44.1, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.33, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "fee schedule", "standard_charge_dollar": 27.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 42.19, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.28 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 31.3, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.28 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 29.94, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 39.47 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 28.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.74 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.83, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.74 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.04, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 28.04, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Commercial", "methodology": "fee schedule", "standard_charge_dollar": 27.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 27.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.28 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 27.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 32.66 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 34.03, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 27.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.04, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY OF SOMATOMEDIN", "code_information": [ { "code": "84305", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 134.0, "discounted_cash": 21.0, "minimum": 9.28, "maximum": 134.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 25.51, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 32.53 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 22.32, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.28 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 20.2, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.28 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 21.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 21.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 28.7, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 29.76, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 34.44, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.76, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "fee schedule", "standard_charge_dollar": 21.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 32.95, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.28 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 134.0 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 24.45, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 134.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.28 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 23.39, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 30.83 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 22.32, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.74 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.32, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 31.89, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.74 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.9, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 21.9, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.32, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 25.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 21.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.28 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 21.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 25.51 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 26.58, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 21.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 134.0 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.9, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "HC BRONCHOSCOPY THERAPEUTIC ASPIR, INIT", "code_information": [ { "code": "31645", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8622.0, "discounted_cash": 1898.0, "minimum": 146.62, "maximum": 6897.6, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 2277.62, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1020.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1898.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 1992.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1554.13 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 1803.12, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1554.13 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 1898.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 1898.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 2562.33, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 2657.23, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3074.79, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1898.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1898.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "fee schedule", "standard_charge_dollar": 1898.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 2941.93, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1554.13 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1898.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2182.72, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1898.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1554.13 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1898.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 2087.82, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1898.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 1400.0 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1898.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 1992.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1631.84 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1992.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2847.03, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1631.84 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1954.96, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 1954.96, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1992.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Commercial", "methodology": "fee schedule", "standard_charge_dollar": 146.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1898.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 146.62 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1898.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1898.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 1553.35 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1554.13 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1898.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1898.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2372.53, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1898.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 1898.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1898.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1954.96, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY OF GAMMAGLOBULIN IGE", "code_information": [ { "code": "82785", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 94.0, "discounted_cash": 16.0, "minimum": 8.41, "maximum": 94.0, "payers_information": [ { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "fee schedule", "standard_charge_dollar": 16.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 25.51, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.41 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 94.0 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.93, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 94.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.41 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 18.11, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 23.87 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 17.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.83 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 24.69, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.83 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.95, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 16.95, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "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": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 16.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.41 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.75 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 20.58, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 16.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 94.0 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.95, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 19.75, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 25.18 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 17.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.41 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 15.64, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.41 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 16.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 16.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 22.22, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 23.04, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 26.67, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.88, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY OF PROGESTERONE 17-D", "code_information": [ { "code": "83498", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 314.0, "discounted_cash": 27.0, "minimum": 9.28, "maximum": 251.2, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 32.6, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 41.57 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 28.53, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.28 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 25.81, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.28 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 27.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 27.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 36.68, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 38.04, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 44.02, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.3, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "fee schedule", "standard_charge_dollar": 27.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 42.11, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.28 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 132.03 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 31.25, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 111.18 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.28 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 29.89, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 39.4 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 28.53, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.74 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.53, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.76, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.74 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.99, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 27.99, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.53, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Commercial", "methodology": "fee schedule", "standard_charge_dollar": 27.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 32.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 27.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.28 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 27.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 32.6 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 33.96, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 27.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 132.03 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.99, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY OF THYROGLOBULIN", "code_information": [ { "code": "84432", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 243.0, "discounted_cash": 16.0, "minimum": 9.28, "maximum": 194.4, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 19.27, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 24.57 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 16.86, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.28 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 15.26, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.28 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 16.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 16.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 21.68, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 22.48, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 26.02, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.64, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "fee schedule", "standard_charge_dollar": 16.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 24.89, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.28 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 158.57 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.47, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 133.54 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.28 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 17.67, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 23.29 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 16.86, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.74 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.86, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 24.09, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.74 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.54, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 16.54, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "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": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 16.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.28 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.27 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 20.08, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 16.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 158.57 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.54, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "HC BRUCELLA, ANTIBODY", "code_information": [ { "code": "86622", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 175.0, "discounted_cash": 8.0, "minimum": 5.358, "maximum": 140.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 10.72, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.66 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 9.38, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.1 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 8.48, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.1 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 8.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 8.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 12.06, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 12.5, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.47, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.36, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "fee schedule", "standard_charge_dollar": 8.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 13.84, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.1 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10.27, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.1 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 9.82, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.95 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 9.38, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.51 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.38, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 13.4, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.51 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.2, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 9.2, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "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": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 8.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.1 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10.72 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 8.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.2, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY OF HAPTOGLOBIN, QUANT", "code_information": [ { "code": "83010", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 110.0, "discounted_cash": 12.0, "minimum": 7.548, "maximum": 110.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 15.1, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.25 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 13.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.41 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 11.95, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.41 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 12.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 12.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 16.98, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 17.61, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 20.38, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.55, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "fee schedule", "standard_charge_dollar": 12.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 19.5, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.41 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 110.0 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.47, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 98.18 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.41 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 13.84, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.24 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 13.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.83 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.21, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.87, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.83 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.96, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 12.96, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "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": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 12.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.41 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.1 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15.73, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 12.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 110.0 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.96, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY OF PROSTATE SPECIFIC ANTIGEN TOTAL - G0103 - 30100312", "code_information": [ { "code": "G0103", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 159.0, "discounted_cash": 19.0, "minimum": 8.1, "maximum": 333.6, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 23.17, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 29.54 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Network", "methodology": "percent of total billed charges", "standard_charge_percentage": 65.0, "median_amount": 24.22, "10th_percentile": 24.22, "90th_percentile": 24.22, "count": "1 through 10" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 20.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 18.34, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 19.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 19.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 26.07, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 27.03, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 31.28, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 69.0, "median_amount": 21.7, "10th_percentile": 21.7, "90th_percentile": 21.7, "count": "1 through 10" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.59, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "fee schedule", "standard_charge_dollar": 19.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 29.93, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 22.21, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 21.24, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 28.0 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 20.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 28.97, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.89, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 19.89, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.28, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 19.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 19.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 23.17 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 24.14, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 19.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.89, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY OF TOTAL ESTRADIOL", "code_information": [ { "code": "82670", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 386.0, "discounted_cash": 27.0, "minimum": 9.28, "maximum": 308.8, "payers_information": [ { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 27.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 162.83 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.78, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 33.53, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 42.75 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 29.34, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.28 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 26.54, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.28 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 27.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 27.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 37.72, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 39.12, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 45.26, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.76, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "fee schedule", "standard_charge_dollar": 27.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 43.31, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.28 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 162.83 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 32.13, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 137.12 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.28 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 30.73, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 40.51 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 29.34, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.74 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.34, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 41.91, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.74 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.78, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 28.78, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "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": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Commercial", "methodology": "fee schedule", "standard_charge_dollar": 27.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 27.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.28 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 27.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 33.53 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 34.93, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.94, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC CARCINOEMBRYONIC ANTIGEN", "code_information": [ { "code": "82378", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 368.0, "discounted_cash": 18.0, "minimum": 8.41, "maximum": 294.4, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 22.75, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 29.01 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 19.91, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.41 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 18.01, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.41 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 18.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 18.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 25.6, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 26.54, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 30.72, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.38, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "fee schedule", "standard_charge_dollar": 18.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 29.39, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.41 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 196.37 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.8, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 165.36 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.41 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 20.86, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 27.49 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 19.91, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.83 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.91, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 28.44, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.83 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.53, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 19.53, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.91, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 22.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 18.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.41 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 22.75 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 23.7, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 18.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 196.37 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.53, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY OF INORGANIC PHOSPHORUS", "code_information": [ { "code": "84100", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 64.0, "discounted_cash": 4.0, "minimum": 2.844, "maximum": 52.9, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 5.69, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.25 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 4.98, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 4.5, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 4.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 4.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 6.4, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 6.64, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.68, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 69.0, "median_amount": 5.15, "10th_percentile": 5.15, "90th_percentile": 44.16, "count": "1 through 10" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.84, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "fee schedule", "standard_charge_dollar": 4.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 7.35, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 52.9 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.45, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 44.54 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 5.21, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.87 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 4.98, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.99 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.98, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.11, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.99 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.88, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 4.88, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "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": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 4.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.69 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5.93, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 4.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 52.9 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.88, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY OF TACROLIMUS", "code_information": [ { "code": "80197", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 311.0, "discounted_cash": 13.0, "minimum": 8.238, "maximum": 248.8, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 16.48, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.01 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 14.42, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.53 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 13.04, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.53 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 13.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 13.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 18.54, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 19.22, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 22.24, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.24, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "fee schedule", "standard_charge_dollar": 13.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 21.28, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.53 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 217.57 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.79, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 183.22 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.53 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 15.1, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.91 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 14.42, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.96 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.42, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 20.6, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.96 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.14, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 14.14, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.42, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 13.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.53 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.48 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.16, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 13.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 217.57 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.14, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY OF TRIGLYCERIDES", "code_information": [ { "code": "84478", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 68.0, "discounted_cash": 5.0, "minimum": 3.444, "maximum": 58.14, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 6.89, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.78 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 6.03, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 5.45, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 5.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 5.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 7.75, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 8.04, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9.3, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.44, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "fee schedule", "standard_charge_dollar": 5.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 8.9, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 58.14 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.6, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 48.96 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 6.31, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.32 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 6.03, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.99 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.03, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.61, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.99 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.91, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 5.91, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.03, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 5.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.89 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.18, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 5.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 58.14 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.91, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY OF METANEPHRINES", "code_information": [ { "code": "83835", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 166.0, "discounted_cash": 16.0, "minimum": 9.28, "maximum": 166.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 20.33, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 25.92 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 17.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.28 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 16.09, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.28 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 16.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 16.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 22.87, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 23.72, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 27.44, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.16, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "fee schedule", "standard_charge_dollar": 16.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 26.26, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.28 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 166.0 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.48, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 166.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.28 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 18.63, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 24.56 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 17.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.74 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 25.41, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.74 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.45, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 17.45, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "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": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 16.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.28 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.33 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.18, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 16.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 166.0 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.45, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY OF TOTAL TESTOSTERONE", "code_information": [ { "code": "84403", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 530.0, "discounted_cash": 25.0, "minimum": 9.28, "maximum": 424.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 30.97, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 39.49 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 27.1, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.28 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 24.52, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.28 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 25.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 25.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 34.84, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 36.13, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 41.81, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 69.0, "median_amount": 365.7, "10th_percentile": 365.7, "90th_percentile": 365.7, "count": "1 through 10" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.49, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "fee schedule", "standard_charge_dollar": 25.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 40.01, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.28 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 159.87 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 29.68, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 134.62 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.28 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 28.39, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 37.42 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 27.1, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.74 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.1, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 38.72, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.74 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.58, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 26.58, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.1, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Commercial", "methodology": "fee schedule", "standard_charge_dollar": 25.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 30.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 25.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.28 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 25.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 30.97 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 32.26, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 25.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 159.87 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.58, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY OF URINE CREATININE", "code_information": [ { "code": "82570", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 51.0, "discounted_cash": 5.0, "minimum": 3.108, "maximum": 51.0, "payers_information": [ { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 51.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 5.7, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.51 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 5.44, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.99 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.44, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.77, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.99 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.34, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 5.34, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "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": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.22 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 51.0 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.34, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 6.22, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.93 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 5.44, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 4.92, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 6.99, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 7.25, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.39, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.11, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 8.03, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 51.0 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.96, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC CHEM CAUTERY GRANULATN TISSUE", "code_information": [ { "code": "17250", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 727.0, "discounted_cash": 213.0, "minimum": 38.63, "maximum": 727.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 256.74, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 727.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 213.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 224.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 143.17 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 203.25, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 143.17 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 213.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 213.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 288.83, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 299.53, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 346.6, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 213.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 727.0 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 213.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "fee schedule", "standard_charge_dollar": 213.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 331.62, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 143.17 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 213.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 246.04, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Medicare", "methodology": "fee schedule", "standard_charge_dollar": 213.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 143.17 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 213.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 235.35, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 213.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 213.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 224.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 150.33 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 224.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 320.93, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 150.33 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 220.37, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 220.37, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 224.65, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Commercial", "methodology": "fee schedule", "standard_charge_dollar": 38.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 213.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 38.63 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 213.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 213.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 143.1 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 143.17 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 213.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 213.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 267.44, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 213.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 213.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 213.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 220.37, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY OF MYOGLOBIN", "code_information": [ { "code": "83874", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 122.0, "discounted_cash": 12.0, "minimum": 7.752, "maximum": 122.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 15.5, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.77 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 13.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.41 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 12.27, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.41 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 12.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 12.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 17.44, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 18.09, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 20.93, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.75, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "fee schedule", "standard_charge_dollar": 12.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 20.03, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.41 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 122.0 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.86, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 110.38 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.41 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 14.21, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.73 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 13.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.83 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.38, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.83 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.31, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 13.31, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "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": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 12.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.41 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.5 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.15, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 12.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 122.0 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.31, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY OF URIC ACID, BLOOD, OTHER SOURCE", "code_information": [ { "code": "84560", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 42.0, "discounted_cash": 5.0, "minimum": 3.048, "maximum": 42.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 6.1, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.77 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 5.33, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 4.83, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 5.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 5.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 6.86, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 7.11, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.23, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.05, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "fee schedule", "standard_charge_dollar": 5.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 7.87, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 42.0 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.84, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 42.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 5.59, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.37 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 5.33, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.99 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.33, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.62, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.99 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.23, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 5.23, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.33, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 5.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.1 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.35, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 5.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 42.0 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.23, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY OF VALPROIC ACID, TOTAL", "code_information": [ { "code": "80164", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 153.0, "discounted_cash": 13.0, "minimum": 8.124, "maximum": 151.29, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 16.25, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.72 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 14.22, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.53 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 12.86, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.53 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 13.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 13.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 18.28, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 18.96, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.93, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.12, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "fee schedule", "standard_charge_dollar": 13.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 20.99, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.53 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 151.29 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.57, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 127.4 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.53 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 14.89, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.63 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 14.22, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.96 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.22, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 20.31, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.96 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.95, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 13.95, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "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": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 13.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.53 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.25 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.93, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 13.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 151.29 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.95, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "HC CHEST X-RAY 4 VW", "code_information": [ { "code": "71048", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 734.0, "discounted_cash": 111.0, "minimum": 30.98, "maximum": 587.2, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 133.78, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 117.05, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 48.7 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 105.91, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 48.7 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 111.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 111.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 150.5, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 156.07, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 180.6, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "fee schedule", "standard_charge_dollar": 111.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 172.79, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 48.7 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 128.2, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 48.7 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 122.63, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 225.0 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 117.05, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 51.14 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 117.05, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 167.22, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 51.14 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.82, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 114.82, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 117.05, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Commercial", "methodology": "fee schedule", "standard_charge_dollar": 30.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 30.98 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 111.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 48.7 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 111.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 239.27 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 139.35, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 111.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.82, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY OF PARATHORMONE", "code_information": [ { "code": "83970", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 304.0, "discounted_cash": 41.0, "minimum": 24.6, "maximum": 243.2, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 49.54, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 63.16 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 41.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 43.34, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.6 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 39.22, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.6 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 41.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 41.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 55.73, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 57.79, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 66.87, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 41.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.77, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "fee schedule", "standard_charge_dollar": 41.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 63.98, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.6 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 213.6 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 41.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 47.47, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Medicare", "methodology": "fee schedule", "standard_charge_dollar": 41.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 179.87 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.6 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 41.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 45.41, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 41.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 59.86 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 41.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 43.34, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.83 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 43.34, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 61.92, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 25.83 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 42.52, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 42.52, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "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": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Commercial", "methodology": "fee schedule", "standard_charge_dollar": 41.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 41.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 48.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 41.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 41.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 24.6 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 41.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 41.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 49.54 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 51.6, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 41.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 41.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 41.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 213.6 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 42.52, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY OF URINE ALBUMIN", "code_information": [ { "code": "82042", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 45.0, "discounted_cash": 7.0, "minimum": 3.8, "maximum": 45.0, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 8.17, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 7.39, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 7.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 7.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 10.5, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 10.89, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.6, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.67, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "fee schedule", "standard_charge_dollar": 7.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 12.06, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 45.0 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.95, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 45.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 8.56, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.28 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 8.17, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.99 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.17, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11.67, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.99 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.01, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 8.01, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.17, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 7.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.34 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9.73, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 7.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 45.0 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.01, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 9.34, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.9 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.78, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY, BLD/SERUM CHOLESTEROL", "code_information": [ { "code": "82465", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 73.0, "discounted_cash": 4.0, "minimum": 2.61, "maximum": 58.4, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.66 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 4.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 4.13, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 4.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 4.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 5.87, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 6.09, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.05, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.61, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "fee schedule", "standard_charge_dollar": 4.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 6.74, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 55.37 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.0, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 46.62 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 4.79, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.31 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 4.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.99 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.53, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.99 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.48, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 4.48, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.57, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 4.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.22 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5.44, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 4.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 55.37 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.48, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "HC CHOLECYSTOSTOMY,PERCUTANEOUS, COMPLETE", "code_information": [ { "code": "47490", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 17645.0, "discounted_cash": 3818.0, "minimum": 321.18, "maximum": 14116.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 4581.62, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3818.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 4008.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1920.87 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3627.12, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1920.87 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 3818.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 3818.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 5154.33, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 5345.23, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6185.19, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3818.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 4550.0 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3818.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "fee schedule", "standard_charge_dollar": 3818.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 5917.93, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1920.87 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3818.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4390.72, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3818.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1920.87 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3818.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 4199.82, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3818.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3818.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 4008.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2016.91 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4008.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5727.03, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2016.91 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3932.56, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 3932.56, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4008.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Commercial", "methodology": "fee schedule", "standard_charge_dollar": 321.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3818.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 321.18 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3818.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3818.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 1919.91 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1920.87 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3818.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3818.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4772.53, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3818.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 3818.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3818.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3932.56, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY OF PROLACTIN", "code_information": [ { "code": "84146", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 168.0, "discounted_cash": 19.0, "minimum": 9.28, "maximum": 168.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 23.26, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 29.65 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 20.35, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.28 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 18.41, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.28 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 19.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 19.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 26.16, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 27.13, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 31.4, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.63, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "fee schedule", "standard_charge_dollar": 19.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 30.04, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.28 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 168.0 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 22.29, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 150.81 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.28 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 21.32, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 28.1 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 20.35, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.74 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.35, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 29.07, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.74 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.96, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 19.96, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.35, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 23.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 19.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.28 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 19.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 23.26 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 24.23, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 19.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 168.0 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.96, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY OF URINE CHLORIDE", "code_information": [ { "code": "82436", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 44.0, "discounted_cash": 5.0, "minimum": 3.45, "maximum": 39.45, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 6.9, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.8 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 6.04, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 5.46, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 5.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 5.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 7.76, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 8.05, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9.32, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.45, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "fee schedule", "standard_charge_dollar": 5.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 8.91, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 39.45 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.61, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 33.22 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 6.33, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.34 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 6.04, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.99 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.04, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.63, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.99 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.92, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 5.92, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "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": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 5.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.9 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.19, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 5.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 39.45 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.92, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "HC ASSTV TECHNOL ASSMT DIR CNTCT W/REPRT EA 15 MIN", "code_information": [ { "code": "97755", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 178.0, "discounted_cash": 38.0, "minimum": 36.48, "maximum": 178.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 46.08, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 40.32, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 164.34 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 36.48, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 164.34 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 38.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 38.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 51.84, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 53.76, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 62.21, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.4 }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "fee schedule", "standard_charge_dollar": 38.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 59.52, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 164.34 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 44.16, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 164.34 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 42.24, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 145.0 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 40.32, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 172.56 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.32, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 57.6, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 172.56 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 39.55, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 39.55, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.32, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Commercial", "methodology": "fee schedule", "standard_charge_dollar": 38.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 38.4 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 38.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 164.26 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 164.34 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 38.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 178.0 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 48.0, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 40.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 39.55, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "HC CLOT INHIB PROTEIN C,ACTIV", "code_information": [ { "code": "85303", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 679.0, "discounted_cash": 13.0, "minimum": 3.11, "maximum": 543.2, "payers_information": [ { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.26, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 14.26, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.53, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 13.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.11 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.61 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.3, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 13.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 304.01 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.26, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 16.61, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.18 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 14.53, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.11 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 13.15, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.11 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 13.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 13.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 18.68, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 19.38, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 22.42, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.3, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "fee schedule", "standard_charge_dollar": 13.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 21.45, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.11 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 304.01 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.92, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 256.01 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.11 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 15.22, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.07 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 14.53, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.27 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.53, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 20.76, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.27 } ] } ] }, { "description": "HC ASSAY OF SELENIUM", "code_information": [ { "code": "84255", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 232.0, "discounted_cash": 25.0, "minimum": 8.66, "maximum": 185.6, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 30.64, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 39.06 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 26.81, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.66 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 24.25, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.66 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 25.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 25.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 34.47, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 35.74, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 41.36, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "fee schedule", "standard_charge_dollar": 25.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 39.57, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.66 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 29.36, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.66 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 28.08, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 37.02 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 26.81, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.09 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.81, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 38.3, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.09 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.3, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 26.3, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "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": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Commercial", "methodology": "fee schedule", "standard_charge_dollar": 25.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 30.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 25.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.66 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 25.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 30.64 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 31.91, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 25.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.3, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY OF URINE OSMOLALITY", "code_information": [ { "code": "83935", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 47.0, "discounted_cash": 6.0, "minimum": 3.8, "maximum": 47.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 8.18, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10.43 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 7.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 6.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 6.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 9.21, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 9.55, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11.05, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.09, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "fee schedule", "standard_charge_dollar": 6.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 10.57, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 47.0 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.84, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 47.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 7.5, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.89 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 7.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.99 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.23, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.99 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.02, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 7.02, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 6.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.18 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.53, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 6.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 47.0 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.02, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "HC BACTERIA CULTURE SCREEN", "code_information": [ { "code": "87081", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 54.0, "discounted_cash": 6.0, "minimum": 3.978, "maximum": 54.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 7.96, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10.14 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 6.96, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.41 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 6.3, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.41 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 6.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 6.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 8.95, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 9.28, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.98, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "fee schedule", "standard_charge_dollar": 6.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 10.28, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.41 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 54.0 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.62, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 54.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.41 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 7.29, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.61 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 6.96, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.78 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.96, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9.95, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.78 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.83, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 6.83, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "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": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 6.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.41 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.96 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.29, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 6.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 54.0 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.83, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "HC CLOT INHIB PROTEIN C,ANTIGEN", "code_information": [ { "code": "85302", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 731.0, "discounted_cash": 12.0, "minimum": 3.11, "maximum": 584.8, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 14.41, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.38 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 12.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.11 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 11.41, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.11 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 12.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 12.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 16.21, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 16.81, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.46, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.21, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "fee schedule", "standard_charge_dollar": 12.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 18.62, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.11 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 197.99 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.81, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 166.73 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.11 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 13.21, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.41 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 12.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.27 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.61, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.02, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.27 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.37, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 12.37, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "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": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 12.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.11 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.41 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15.01, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 12.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 197.99 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.37, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY OF SERUM ALBUMIN", "code_information": [ { "code": "82040", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 44.0, "discounted_cash": 4.0, "minimum": 2.97, "maximum": 44.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 5.94, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.57 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 5.2, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 4.7, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 4.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 4.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 6.68, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 6.93, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.02, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.97, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "fee schedule", "standard_charge_dollar": 4.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 7.67, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 44.0 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.69, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 44.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 5.45, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.18 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 5.2, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.99 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.2, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.43, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.99 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.1, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 5.1, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.2, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 4.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.94 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.19, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 4.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 44.0 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.1, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY OF VALPROIC ACID, FREE", "code_information": [ { "code": "80165", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 104.0, "discounted_cash": 13.0, "minimum": 8.124, "maximum": 83.2, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 16.25, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.72 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 14.22, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.53 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 12.86, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.53 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 13.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 13.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 18.28, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 18.96, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.93, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.12, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "fee schedule", "standard_charge_dollar": 13.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 20.99, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.53 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.57, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.53 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 14.89, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.63 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 14.22, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.96 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.22, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 20.31, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.96 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.95, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 13.95, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "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": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 13.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.53 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.25 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.93, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 13.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.95, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "HC BACTERIUM, ANTIBODY", "code_information": [ { "code": "86609", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 16.0, "discounted_cash": 12.0, "minimum": 4.208, "maximum": 16.0, "payers_information": [ { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.73, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 16.0, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.1 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 16.0 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.81, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 16.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.1 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 14.17, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.0 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 13.52, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.51 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.52, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.0, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.51 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.27, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 13.27, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "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": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.1 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.46 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.0, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 16.0 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.27, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 15.46, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 13.52, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.1 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 12.24, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.1 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 16.0, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 16.0, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.0, "additional_payer_notes": "162.00% of Medicare Rates" } ] } ] }, { "description": "HC CMV ANTIBODY", "code_information": [ { "code": "86644", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 93.0, "discounted_cash": 14.0, "minimum": 8.1, "maximum": 93.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 22.02 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 15.11, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.1 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 13.67, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.1 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 14.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 14.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 19.43, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 20.15, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 23.31, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.63, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "fee schedule", "standard_charge_dollar": 14.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 22.3, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.1 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 93.0 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.55, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 93.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.1 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 15.83, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.87 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 15.11, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.51 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.11, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.59, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.51 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.82, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 14.82, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "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": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 14.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.1 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.27 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.99, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 14.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 93.0 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.82, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY OF SEX HORMONE BINDING GLOBULIN", "code_information": [ { "code": "84270", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 333.0, "discounted_cash": 21.0, "minimum": 8.41, "maximum": 266.4, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 26.08, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 33.25 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 22.82, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.41 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 20.64, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.41 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 21.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 21.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 29.34, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 30.42, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 35.2, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 69.0, "median_amount": 229.77, "10th_percentile": 229.77, "90th_percentile": 229.77, "count": "1 through 10" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.04, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "fee schedule", "standard_charge_dollar": 21.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 33.68, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.41 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 127.36 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 24.99, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 107.25 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.41 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 23.9, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 31.51 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 22.82, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.83 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.82, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 32.6, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.83 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.38, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 22.38, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.82, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 25.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 21.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.41 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 21.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 26.08 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 27.16, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 21.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 127.36 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.38, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY OF VITAMIN B-6", "code_information": [ { "code": "84207", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 253.0, "discounted_cash": 28.0, "minimum": 16.86, "maximum": 202.4, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 33.72, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 42.99 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 29.51, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.8 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 26.7, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.8 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 28.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 28.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 37.94, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 39.34, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 45.52, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.86, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "fee schedule", "standard_charge_dollar": 28.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 43.56, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.8 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 32.32, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.8 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 30.91, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 40.75 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 29.51, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.79 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.51, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 42.15, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.79 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.94, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 28.94, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.51, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Commercial", "methodology": "fee schedule", "standard_charge_dollar": 28.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 33.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 28.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.8 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 28.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 33.72 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 35.13, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 28.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.94, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "HC BARTONELLA, ANTIBODY", "code_information": [ { "code": "86611", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 50.0, "discounted_cash": 10.0, "minimum": 6.108, "maximum": 40.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 12.22, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.58 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 10.69, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.1 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 9.67, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.1 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 13.74, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 14.25, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.49, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.11, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 15.78, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.1 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.71, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.1 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 11.2, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.76 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 10.69, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.51 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.69, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15.27, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.51 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.49, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 10.49, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "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": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.1 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.22 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.73, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.49, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "HC CMV ANTIBODY, IGM", "code_information": [ { "code": "86645", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 111.0, "discounted_cash": 16.0, "minimum": 8.1, "maximum": 111.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 20.22, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 25.78 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 17.69, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.1 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 16.01, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.1 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 16.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 16.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 22.75, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 23.59, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 27.3, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.11, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "fee schedule", "standard_charge_dollar": 16.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 26.12, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.1 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 111.0 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.38, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 111.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.1 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 18.54, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 24.43 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 17.69, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.51 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.69, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 25.28, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.51 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.36, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 17.36, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "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": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 16.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.1 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.22 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.06, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 16.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 111.0 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.36, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY OF TROPONIN, QUANT", "code_information": [ { "code": "84484", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 412.0, "discounted_cash": 12.0, "minimum": 7.482, "maximum": 329.6, "payers_information": [ { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 12.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.41 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.96 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15.59, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 12.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 144.63 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.84, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 14.96, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.08 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 13.09, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.41 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.41 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 12.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 12.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 16.83, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 17.46, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 20.2, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.48, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "fee schedule", "standard_charge_dollar": 12.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 19.33, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.41 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 144.63 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.34, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 121.79 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.41 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 13.72, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.08 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 13.09, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.83 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.09, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.71, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.83 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.84, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 12.84, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.09, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.0 } ] } ] }, { "description": "HC ASSAY OF VITAMIN E", "code_information": [ { "code": "84446", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 85.0, "discounted_cash": 14.0, "minimum": 8.41, "maximum": 85.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 17.02, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.7 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 14.89, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.41 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 13.47, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.41 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 14.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 14.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 19.14, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 19.85, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 22.97, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.51, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "fee schedule", "standard_charge_dollar": 14.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 21.98, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.41 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 85.0 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.31, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 77.11 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.41 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 15.6, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.56 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 14.89, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.83 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.89, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.27, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.83 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.61, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 14.61, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "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": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 14.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.41 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.02 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.73, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 14.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 85.0 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.61, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "HC BILIRUBIN DIRECT", "code_information": [ { "code": "82248", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 44.0, "discounted_cash": 5.0, "minimum": 3.012, "maximum": 44.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 6.02, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.68 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 5.27, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 4.77, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 6.78, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 7.03, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.13, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.01, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 7.78, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 44.0 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.77, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 44.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 5.52, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.28 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 5.27, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.99 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.27, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.53, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.99 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.17, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 5.17, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "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": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.02 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.28, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 44.0 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.17, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "HC COLLECTION CAPILLARY BLOOD SPECIMEN", "code_information": [ { "code": "36416", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 29.0, "minimum": 2.37, "maximum": 23.2, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2.37 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2.37 }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2.37 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2.37 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2.49 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2.49 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 2.37 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10.87 }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 3.33, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY OF URIC ACID, BLOOD", "code_information": [ { "code": "84550", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 64.0, "discounted_cash": 4.0, "minimum": 2.712, "maximum": 54.5, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 5.42, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.92 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 4.29, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 4.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 4.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 6.1, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 6.33, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.32, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 69.0, "median_amount": 44.16, "10th_percentile": 44.16, "90th_percentile": 44.16, "count": "1 through 10" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.71, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "fee schedule", "standard_charge_dollar": 4.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 7.01, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 54.5 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.2, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 45.9 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 4.97, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.55 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.99 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.78, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.99 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.66, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 4.66, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "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": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 4.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.42 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5.65, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 4.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 54.5 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.66, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY OF VITAMIN K", "code_information": [ { "code": "84597", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 167.0, "discounted_cash": 13.0, "minimum": 8.232, "maximum": 133.6, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 16.46, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.99 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 14.41, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.41 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 13.03, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.41 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 13.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 13.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 18.52, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 19.21, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 22.23, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.23, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "fee schedule", "standard_charge_dollar": 13.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 21.27, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.41 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.78, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.41 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 15.09, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.89 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 14.41, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.83 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.41, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 20.58, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.83 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.13, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 14.13, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "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": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 13.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.41 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.46 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.15, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 13.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.13, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "HC BLOOD CULTURE FOR BACTERIA", "code_information": [ { "code": "87040", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 436.0, "discounted_cash": 10.0, "minimum": 6.192, "maximum": 348.8, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 12.38, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.79 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 10.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.41 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 9.8, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.41 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 10.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 10.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 13.93, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 14.45, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.72, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.19, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "fee schedule", "standard_charge_dollar": 10.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 16.0, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.41 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 169.08 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.87, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 142.38 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.41 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 11.35, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.96 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 10.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.78 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15.48, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.78 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.63, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 10.63, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "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": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 10.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.41 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 10.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.38 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 10.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 169.08 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.63, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "HC COMPATIBILITY TEST, ELECTRONIC", "code_information": [ { "code": "86923", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 252.0, "discounted_cash": 181.0, "minimum": 24.0, "maximum": 252.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 218.02, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 40.41 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 181.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 190.76, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 113.96 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 172.6, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 113.96 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 181.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 181.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 245.27, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 252.0, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 252.0, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 181.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 181.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "fee schedule", "standard_charge_dollar": 181.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 252.0, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 113.96 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 181.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 208.93, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Medicare", "methodology": "fee schedule", "standard_charge_dollar": 181.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 113.96 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 181.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 199.85, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 181.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 181.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 190.76, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 119.66 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 190.76, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 252.0, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 119.66 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 187.13, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 187.13, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 190.76, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Commercial", "methodology": "fee schedule", "standard_charge_dollar": 181.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 181.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 24.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 181.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 181.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 113.96 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 181.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 181.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 205.63 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 227.1, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 181.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 49.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 181.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 187.13, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY OF URINE PHOSPHORUS", "code_information": [ { "code": "84105", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 80.0, "discounted_cash": 5.0, "minimum": 3.468, "maximum": 78.47, "payers_information": [ { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.47, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "fee schedule", "standard_charge_dollar": 5.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 8.96, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 78.47 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.65, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 66.08 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 6.36, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.38 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 6.07, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.99 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.07, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.67, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.99 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.95, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 5.95, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.07, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 5.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.94 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.23, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 5.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 78.47 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.95, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 6.94, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.84 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 6.07, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 5.49, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 5.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 5.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 7.8, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 8.09, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9.36, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.78, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY OF ZINC", "code_information": [ { "code": "84630", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 218.0, "discounted_cash": 11.0, "minimum": 6.834, "maximum": 174.4, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 13.67, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.43 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 11.96, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.66 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 10.82, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.66 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 11.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 11.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 15.38, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 15.95, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.45, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.83, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "fee schedule", "standard_charge_dollar": 11.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 17.65, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.66 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.1, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.66 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 12.53, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.52 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 11.96, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.09 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.96, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.09, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.09 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.73, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 11.73, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "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": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 11.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.66 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "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": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.67 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.24, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 11.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.73, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "HC BLOOD TRANSFUSION SERVICE", "code_information": [ { "code": "36430", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 598.0, "discounted_cash": 470.0, "minimum": 48.96, "maximum": 598.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 564.54, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 598.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 470.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 493.97, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 350.17 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 446.93, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 350.17 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 470.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 470.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 598.0, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 598.0, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 598.0, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 470.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 470.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "fee schedule", "standard_charge_dollar": 470.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 598.0, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 350.17 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 470.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 541.02, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Medicare", "methodology": "fee schedule", "standard_charge_dollar": 470.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 350.17 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 470.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 517.5, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 470.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 470.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 493.97, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 367.68 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 493.97, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 598.0, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 367.68 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 484.56, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 484.56, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 493.97, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Commercial", "methodology": "fee schedule", "standard_charge_dollar": 48.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 470.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 48.96 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 470.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 470.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 350.0 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 350.17 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 470.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 470.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 588.06, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 470.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 470.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 470.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 484.56, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "HC COMPATIBILITY TEST,ANTIGLOB TECH", "code_information": [ { "code": "86922", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 252.0, "discounted_cash": 181.0, "minimum": 19.01, "maximum": 252.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 218.02, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 54.04 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 181.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 190.76, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 113.96 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 172.6, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 113.96 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 181.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 181.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 245.27, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 252.0, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 252.0, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 181.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 181.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "fee schedule", "standard_charge_dollar": 181.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 252.0, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 113.96 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 140.05 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 181.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 208.93, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Medicare", "methodology": "fee schedule", "standard_charge_dollar": 181.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 117.94 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 113.96 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 181.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 199.85, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 181.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 181.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 190.76, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 119.66 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 190.76, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 252.0, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 119.66 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 187.13, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 187.13, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 190.76, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Commercial", "methodology": "fee schedule", "standard_charge_dollar": 181.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 181.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 31.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 181.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 181.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 113.96 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 181.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 181.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 205.63 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 227.1, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 181.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 19.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 181.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 140.05 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 187.13, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY OF URINE POTASSIUM", "code_information": [ { "code": "84133", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 38.0, "discounted_cash": 4.0, "minimum": 2.838, "maximum": 38.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 5.68, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.24 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 4.97, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 4.49, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 4.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 4.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 6.39, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 6.62, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.66, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.84, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "fee schedule", "standard_charge_dollar": 4.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 7.33, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 38.0 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.44, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 38.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 5.2, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.86 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 4.97, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.99 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.97, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.1, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.99 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.87, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 4.87, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.97, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 4.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.68 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5.91, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 4.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 38.0 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.87, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY SNGL ORGANIC ACID, QUANTITATIVE", "code_information": [ { "code": "83921", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 252.0, "discounted_cash": 21.0, "minimum": 8.41, "maximum": 239.04, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 32.45 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 22.27, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.41 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 20.15, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.41 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 21.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 21.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 28.63, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 29.69, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 34.36, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.73, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "fee schedule", "standard_charge_dollar": 21.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 32.88, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.41 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 239.04 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 24.39, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 201.3 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.41 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 23.33, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 30.75 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 22.27, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.83 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.27, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 31.82, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.83 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.85, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 21.85, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.27, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 21.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.41 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 21.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 25.45 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 26.51, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 21.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 239.04 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.85, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "HC C-REACTIVE PROTEIN", "code_information": [ { "code": "86140", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 100.0, "discounted_cash": 5.0, "minimum": 3.108, "maximum": 80.0, "payers_information": [ { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.22 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 78.21 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.34, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 6.22, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.93 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 5.44, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.1 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 4.92, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.1 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 6.99, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 7.25, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.39, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.11, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 8.03, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.1 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 78.21 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.96, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 65.86 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.1 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 5.7, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.51 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 5.44, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.51 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.44, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.77, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.51 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.34, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 5.34, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "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": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.1 } ] } ] }, { "description": "HC COMPLEMENT, TOTAL (CH50)", "code_information": [ { "code": "86162", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 234.0, "discounted_cash": 20.0, "minimum": 8.1, "maximum": 187.2, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 24.38, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 31.09 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 21.34, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.1 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 19.3, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.1 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 20.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 20.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 27.43, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 28.45, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 32.92, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.19, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "fee schedule", "standard_charge_dollar": 20.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 31.5, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.1 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 161.84 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 23.37, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 136.29 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.1 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 22.35, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 29.46 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 21.34, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.51 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.34, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 30.48, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.51 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.93, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 20.93, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "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": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 24.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 20.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.1 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 20.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 24.38 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 25.4, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 20.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 161.84 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.93, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY OF VANCOMYCIN", "code_information": [ { "code": "80202", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 147.0, "discounted_cash": 13.0, "minimum": 8.124, "maximum": 147.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 16.25, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.72 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 14.22, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.53 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 12.86, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.53 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 13.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 13.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 18.28, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 18.96, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.93, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.12, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "fee schedule", "standard_charge_dollar": 13.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 20.99, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.53 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 147.0 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.57, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 143.92 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.53 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 14.89, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.63 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 14.22, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.96 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.22, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 20.31, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.96 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.95, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 13.95, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "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": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 13.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.53 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.25 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.93, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 13.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 147.0 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.95, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY TEST FOR BLOOD FECAL", "code_information": [ { "code": "82274", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 89.0, "discounted_cash": 15.0, "minimum": 8.41, "maximum": 71.2, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 19.1, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 24.36 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 16.72, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.41 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 15.12, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.41 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 15.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 15.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 21.49, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 22.29, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 25.79, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.55, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "fee schedule", "standard_charge_dollar": 15.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 24.68, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.41 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.31, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.41 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 17.51, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 23.08 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 16.72, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.83 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.72, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 23.88, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.83 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.4, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 16.4, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.72, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 15.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.41 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 15.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.1 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.9, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 15.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.4, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "HC CARDIOLIPIN ANTIBODY", "code_information": [ { "code": "86147", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 96.0, "discounted_cash": 25.0, "minimum": 8.1, "maximum": 96.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 30.54, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 38.94 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 26.72, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.1 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 24.18, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.1 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 34.36, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 35.63, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 41.23, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.27, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 39.45, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.1 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 96.0 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 29.27, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 96.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.1 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 28.0, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 36.9 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 26.72, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.51 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.72, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 38.18, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.51 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.21, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 26.21, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "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": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Commercial", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 30.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.1 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 30.54 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 31.81, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 96.0 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.21, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "HC CT GUIDANCE NEEDLE PLACEMENT", "code_information": [ { "code": "77012", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1849.0, "minimum": 56.49, "maximum": 1479.2, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 71.43 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 71.43 }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 71.43 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 71.43 }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 800.0 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 75.0 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 75.0 }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Commercial", "methodology": "fee schedule", "standard_charge_dollar": 56.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 56.49 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 71.43 } ] } ] }, { "description": "HC ASSAY OF VITAMIN B-2", "code_information": [ { "code": "84252", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 118.0, "discounted_cash": 20.0, "minimum": 8.41, "maximum": 94.4, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 24.29, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 30.97 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 21.25, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.41 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 19.23, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.41 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 20.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 20.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 27.32, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 28.34, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 32.79, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.14, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "fee schedule", "standard_charge_dollar": 20.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 31.37, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.41 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 23.28, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.41 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 22.26, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 29.35 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 21.25, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.83 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.25, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 30.36, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.83 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.85, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 20.85, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.25, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 20.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.41 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 20.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 24.29 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 25.3, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 20.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.85, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "HC BCR/ABL1 GENE MINOR BP", "code_information": [ { "code": "81207", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1341.0, "discounted_cash": 144.0, "minimum": 86.904, "maximum": 1072.8, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 173.81, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 221.61 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 144.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 152.08, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 115.83 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 137.6, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 115.83 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 144.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 144.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 195.53, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 202.78, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 234.64, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 144.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 86.9, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "fee schedule", "standard_charge_dollar": 144.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 224.5, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 115.83 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 144.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 166.57, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Medicare", "methodology": "fee schedule", "standard_charge_dollar": 144.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 115.83 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 144.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 159.32, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 144.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 210.02 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 144.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 152.08, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 121.62 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 152.08, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 217.26, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 121.62 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 149.19, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 149.19, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 152.08, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Commercial", "methodology": "fee schedule", "standard_charge_dollar": 144.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 144.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 144.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 144.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 115.83 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 144.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 144.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 173.81 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 181.05, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 144.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 144.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 144.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 149.19, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "HC CATHETER ASPIRATN NASOTRACH", "code_information": [ { "code": "31720", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 395.0, "discounted_cash": 233.0, "minimum": 49.6, "maximum": 395.0, "payers_information": [ { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 361.93, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 49.94 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 233.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 268.53, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Medicare", "methodology": "fee schedule", "standard_charge_dollar": 233.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 49.94 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 233.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 256.85, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 233.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 395.0 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 233.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 245.18, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 52.44 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 245.18, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 350.25, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 52.44 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 240.51, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 240.51, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 245.18, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Commercial", "methodology": "fee schedule", "standard_charge_dollar": 49.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 233.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 49.6 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 233.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 233.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 49.92 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 49.94 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 233.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 233.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 291.88, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 233.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 233.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 233.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 240.51, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 280.2, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 395.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 233.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 245.18, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 49.94 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 221.83, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 49.94 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 233.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 233.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 315.23, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 326.9, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 378.27, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 233.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 395.0 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 233.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "fee schedule", "standard_charge_dollar": 233.5, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC CT SCAN ABDOMEN/PELVIS WO CONTRAST", "code_information": [ { "code": "74176", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3904.0, "discounted_cash": 254.0, "minimum": 104.59, "maximum": 3123.2, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 305.33, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 67.1, "median_amount": 2619.58, "10th_percentile": 2619.58, "90th_percentile": 2619.58, "count": "1 through 10" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 254.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 267.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 263.61 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 241.72, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 263.61 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 254.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 254.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 343.49, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 356.22, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 412.19, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 254.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 254.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "fee schedule", "standard_charge_dollar": 254.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 394.38, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 263.61 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 254.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 292.61, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Medicare", "methodology": "fee schedule", "standard_charge_dollar": 254.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 263.61 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 254.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 279.88, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 254.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 800.0 }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30.0, "median_amount": 1171.2, "10th_percentile": 1171.2, "90th_percentile": 1171.2, "count": "1 through 10" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 254.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 267.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 276.79 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 267.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 381.66, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 276.79 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 262.07, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 262.07, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 267.16, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Commercial", "methodology": "fee schedule", "standard_charge_dollar": 104.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 254.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 104.59 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 254.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 254.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 263.48 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 263.61 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 254.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 254.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 543.87 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 318.05, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 254.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 254.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 254.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 262.07, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY QUANTITATIVE,BLOOD GLUCOSE", "code_information": [ { "code": "82947", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 48.0, "discounted_cash": 3.0, "minimum": 2.358, "maximum": 46.75, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 4.72, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.01 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 4.13, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3.73, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 3.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 3.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 5.31, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 5.5, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.37, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.36, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "fee schedule", "standard_charge_dollar": 3.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 6.09, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 46.75 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4.52, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 39.37 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 4.32, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.7 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 4.13, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.99 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.13, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5.9, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.99 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.05, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 4.05, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "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": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4.72 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4.91, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 3.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 46.75 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.05, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "HC BILIRUBIN TOTAL", "code_information": [ { "code": "82247", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 44.0, "discounted_cash": 5.0, "minimum": 3.012, "maximum": 44.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 6.02, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.68 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 5.27, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 4.77, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 6.78, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 7.03, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.13, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.01, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 7.78, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 44.0 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.77, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 44.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 5.52, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.28 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 5.27, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.99 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.27, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.53, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.99 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.17, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 5.17, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "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": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.02 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.28, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 44.0 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.17, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "HC CHORIONIC GONADOTROPIN, QUAL", "code_information": [ { "code": "84703", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 302.0, "discounted_cash": 7.0, "minimum": 3.8, "maximum": 241.6, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 9.02, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.51 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 7.9, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 7.14, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 7.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 7.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 10.15, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 10.53, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.18, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.51, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "fee schedule", "standard_charge_dollar": 7.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 11.66, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 96.19 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 81.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 8.27, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10.9 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 7.9, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.99 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.9, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11.28, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.99 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.75, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 7.75, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "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": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 7.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.02 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9.4, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 7.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 96.19 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.75, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "HC CT SCAN HEAD COMBO", "code_information": [ { "code": "70470", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4932.0, "discounted_cash": 187.0, "minimum": 116.0, "maximum": 3945.6, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 224.45, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 187.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 196.39, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 263.61 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 177.69, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 263.61 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 187.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 187.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 252.5, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 261.86, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 303.0, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 187.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 187.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "fee schedule", "standard_charge_dollar": 187.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 289.91, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 263.61 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 1779.02 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 187.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 215.1, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Medicare", "methodology": "fee schedule", "standard_charge_dollar": 187.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 1498.12 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 263.61 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 187.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 205.74, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 187.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 800.0 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 187.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 196.39, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 276.79 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 196.39, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 280.56, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 276.79 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 192.65, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 192.65, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 196.39, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Commercial", "methodology": "fee schedule", "standard_charge_dollar": 116.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 187.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 116.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 187.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 187.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 263.48 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 263.61 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 187.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 187.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 400.55 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 233.8, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 187.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 187.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 187.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 1779.02 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 192.65, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY THYROID STIM HORMONE", "code_information": [ { "code": "84443", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 183.0, "discounted_cash": 16.0, "minimum": 9.28, "maximum": 146.4, "payers_information": [ { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 16.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.28 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.16 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.0, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 16.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 143.62 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.3, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 20.16, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 25.7 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 17.64, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.28 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 15.96, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.28 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 16.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 16.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 22.68, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 23.52, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 27.22, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 69.0, "median_amount": 126.27, "10th_percentile": 18.76, "90th_percentile": 126.27, "count": "1 through 10" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.08, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "fee schedule", "standard_charge_dollar": 16.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 26.04, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.28 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 143.62 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.32, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 120.94 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.28 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 18.48, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 24.36 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 17.64, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.74 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.64, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 25.2, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.74 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.3, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 17.3, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "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": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.8, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC BLOOD COUNT AUTOMATED DIFFERENTIAL WBC COUNT", "code_information": [ { "code": "85004", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 101.0, "discounted_cash": 6.0, "minimum": 3.882, "maximum": 80.8, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 7.76, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.9 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 6.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.17 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 6.15, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.17 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 8.73, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 9.06, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.48, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.88, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 10.03, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.17 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 55.31 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.44, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 46.58 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.17 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 7.12, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.38 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 6.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.38 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9.71, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.38 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.66, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 6.66, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.79, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.17 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.76 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.09, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 55.31 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.66, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "HC CHROMOSOME ANAL:15-20,2 KARYOTYPES", "code_information": [ { "code": "88262", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2106.0, "discounted_cash": 125.0, "minimum": 32.76, "maximum": 1684.8, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 150.59, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 192.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 125.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 131.76, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 32.76 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 119.22, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 32.76 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 125.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 125.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 169.41, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 175.69, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 203.29, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 125.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 75.29, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "fee schedule", "standard_charge_dollar": 125.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 194.51, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 32.76 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 483.12 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 125.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 144.31, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Medicare", "methodology": "fee schedule", "standard_charge_dollar": 125.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 406.84 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 32.76 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 125.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 138.04, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 125.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 181.96 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 125.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 131.76, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 34.4 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.76, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 188.24, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 34.4 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 129.25, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 129.25, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 131.76, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Commercial", "methodology": "fee schedule", "standard_charge_dollar": 125.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 125.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 146.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 125.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 125.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 32.76 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 125.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 125.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 150.59 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 156.86, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 125.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 125.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 125.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 483.12 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 129.25, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "HC CT SCAN OF ABDOMEN CONTRAST", "code_information": [ { "code": "74160", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5655.0, "discounted_cash": 187.0, "minimum": 173.4, "maximum": 4524.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 224.45, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 187.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 196.39, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 263.61 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 177.69, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 263.61 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 187.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 187.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 252.5, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 261.86, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 303.0, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 187.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 187.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "fee schedule", "standard_charge_dollar": 187.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 289.91, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 263.61 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 1691.13 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 187.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 215.1, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Medicare", "methodology": "fee schedule", "standard_charge_dollar": 187.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 1424.11 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 263.61 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 187.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 205.74, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 187.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 800.0 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 187.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 196.39, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 276.79 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 196.39, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 280.56, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 276.79 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 192.65, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 192.65, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 196.39, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Commercial", "methodology": "fee schedule", "standard_charge_dollar": 173.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 187.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 173.4 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 187.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 187.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 263.48 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 263.61 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 187.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 187.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 400.55 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 233.8, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 187.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 187.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 187.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 1691.13 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 192.65, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY URINE UREA-N", "code_information": [ { "code": "84540", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 43.0, "discounted_cash": 5.0, "minimum": 3.336, "maximum": 43.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 6.67, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.51 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 5.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 5.28, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 5.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 5.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 7.51, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 7.78, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9.01, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.34, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "fee schedule", "standard_charge_dollar": 5.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 8.62, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 43.0 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.39, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 43.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 6.12, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.06 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 5.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.99 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.34, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.99 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.73, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 5.73, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "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": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 5.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.67 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.95, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 5.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 43.0 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.73, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "HC BLOOD PH", "code_information": [ { "code": "82800", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 44.0, "discounted_cash": 11.0, "minimum": 6.6, "maximum": 35.2, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 13.2, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.83 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 11.55, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.41 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 10.45, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.41 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 11.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 11.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 14.85, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 15.4, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.82, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.6, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "fee schedule", "standard_charge_dollar": 11.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 17.05, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.41 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.65, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.41 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 12.1, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.95 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 11.55, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.83 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.55, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.5, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.83 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.33, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 11.33, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.55, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 11.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.41 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.2 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 13.75, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 11.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.0, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.33, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "HC CHROMOTOGRAPHY, QUANT, SINGLE", "code_information": [ { "code": "82542", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 80.0, "discounted_cash": 24.0, "minimum": 8.41, "maximum": 64.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 28.91, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 36.86 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 25.29, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.41 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 22.89, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.41 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 24.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 24.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 32.52, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 33.73, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 39.03, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.45, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "fee schedule", "standard_charge_dollar": 24.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 37.34, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.41 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 27.7, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.41 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 26.5, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 34.93 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 25.29, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.83 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.29, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 36.14, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.83 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.81, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 24.81, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.29, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Commercial", "methodology": "fee schedule", "standard_charge_dollar": 24.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 24.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.41 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 24.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 28.91 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 30.11, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 24.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.81, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "HC CT SCAN OF LEG CONTRAST", "code_information": [ { "code": "73701", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1848.0, "discounted_cash": 187.0, "minimum": 113.99, "maximum": 1478.4, "payers_information": [ { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 263.61 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 1435.92 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 187.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 215.1, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Medicare", "methodology": "fee schedule", "standard_charge_dollar": 187.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 1209.19 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 263.61 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 187.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 205.74, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 187.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 800.0 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 187.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 196.39, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 276.79 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 196.39, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 280.56, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 276.79 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 192.65, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 192.65, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 196.39, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Commercial", "methodology": "fee schedule", "standard_charge_dollar": 113.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 187.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 113.99 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 187.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 187.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 263.48 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 263.61 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 187.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 187.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 400.55 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 233.8, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 187.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 187.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 187.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 1435.92 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 192.65, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 224.45, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 187.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 196.39, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 263.61 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 177.69, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 263.61 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 187.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 187.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 252.5, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 261.86, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 303.0, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 187.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 187.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "fee schedule", "standard_charge_dollar": 187.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 289.91, "additional_payer_notes": "155.00% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY VIT D, 25-HYDROXY W FRACTIONS", "code_information": [ { "code": "82306", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 189.0, "discounted_cash": 29.0, "minimum": 17.76, "maximum": 189.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 35.52, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 45.29 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 31.08, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.8 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 28.12, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.8 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 29.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 29.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 39.96, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 41.44, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 47.95, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "percent of total billed charges", "standard_charge_percentage": 69.0, "median_amount": 130.41, "10th_percentile": 33.1, "90th_percentile": 130.41, "count": "1 through 10" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.76, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "fee schedule", "standard_charge_dollar": 29.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 45.88, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.8 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 189.0 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 34.04, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 189.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.8 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 32.56, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 42.92 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 31.08, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.79 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 31.08, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 44.4, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.79 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30.49, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 30.49, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "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": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Commercial", "methodology": "fee schedule", "standard_charge_dollar": 29.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 35.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 29.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.8 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 29.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 35.52 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 37.0, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 29.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 189.0 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30.49, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "HC BLOOD SMEAR INTERPRETATION", "code_information": [ { "code": "85060", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 145.0, "minimum": 4.17, "maximum": 116.0, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 37.26 }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.17 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.17 }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.17 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 81.05 }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 68.26 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.17 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.38 }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.38 }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.02 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.17 }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 27.17 }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 81.05 } ] } ] }, { "description": "HC CHYLMD PNEUM DNA AMP PROBE", "code_information": [ { "code": "87486", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 101.0, "discounted_cash": 35.0, "minimum": 21.054, "maximum": 80.8, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 42.11, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 53.69 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 36.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.14 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 33.34, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.14 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 47.37, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 49.13, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 56.85, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.05, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 54.39, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.14 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 40.35, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.14 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 38.6, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 50.88 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 36.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.65 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 52.64, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.65 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.14, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 36.14, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "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": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Commercial", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 41.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.14 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 42.11 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 43.86, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.14, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "HC CULTURE SPEC, BACTERIA, NOT URINE,STOOL,BLOOD", "code_information": [ { "code": "87070", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 153.0, "discounted_cash": 8.0, "minimum": 5.172, "maximum": 122.4, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 10.34, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.19 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 9.05, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.41 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 8.19, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.41 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 8.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 8.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 11.64, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 12.07, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 13.96, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.17, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "fee schedule", "standard_charge_dollar": 8.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 13.36, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.41 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 117.53 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.91, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 98.98 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.41 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 9.48, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.5 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 9.05, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.78 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.05, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.93, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.78 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.88, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 8.88, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "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": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 8.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.41 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10.34 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.78, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 8.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 117.53 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.88, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY, NON-ENDOCRINE RECEPTOR", "code_information": [ { "code": "84238", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 184.0, "discounted_cash": 36.0, "minimum": 19.8, "maximum": 184.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 43.88, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 55.95 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 38.4, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.8 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 34.74, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.8 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 36.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 36.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 49.37, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 51.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 59.24, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.94, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "fee schedule", "standard_charge_dollar": 36.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 56.68, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.8 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 184.0 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 42.06, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 184.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.8 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 40.23, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 53.03 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 38.4, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.79 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.4, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 54.86, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 20.79 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 37.67, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 37.67, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.4, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Commercial", "methodology": "fee schedule", "standard_charge_dollar": 36.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 43.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 36.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 19.8 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 36.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 43.88 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 45.71, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 36.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 184.0 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 37.67, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "HC BLOOD SMEAR MICRO EXAM W/O MANUAL DIFF", "code_information": [ { "code": "85008", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 17.0, "discounted_cash": 3.0, "minimum": 2.058, "maximum": 17.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 4.12, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.25 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3.6, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.17 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3.26, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.17 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 3.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 3.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 4.63, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 4.8, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5.56, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2.06, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "fee schedule", "standard_charge_dollar": 3.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 5.32, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.17 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 17.0 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3.94, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 17.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.17 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 3.77, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4.97 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 3.6, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.38 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.6, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5.15, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.38 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.53, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 3.53, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.6, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 3.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 4.17 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4.12 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4.29, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 3.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 17.0 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.53, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "HC CLOSTRIDIUM AG, EIA", "code_information": [ { "code": "87324", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 44.0, "discounted_cash": 11.0, "minimum": 7.188, "maximum": 44.0, "payers_information": [ { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.78 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.34, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 12.34, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "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": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.41 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.38 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.98, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 44.0 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.34, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 14.38, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.33 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 12.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.41 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 11.38, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.41 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 16.17, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.41, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.19, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 18.57, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.41 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 44.0 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.78, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 44.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.41 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 13.18, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.37 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 12.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.78 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.58, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.97, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "HC CYSTATIN C", "code_information": [ { "code": "82610", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 112.0, "discounted_cash": 18.0, "minimum": 8.41, "maximum": 89.6, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 22.22, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 28.34 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 19.45, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.41 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 17.59, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.41 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 18.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 18.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 25.0, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 25.93, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 30.0, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.11, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "fee schedule", "standard_charge_dollar": 18.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 28.71, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.41 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.3, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.41 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 20.37, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 26.85 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 19.45, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.83 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.45, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 27.78, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.83 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.08, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 19.08, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.45, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 18.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.41 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 22.22 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 23.15, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 18.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.08, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "HC ASSAY, THREE CATECHOLAMINES", "code_information": [ { "code": "82384", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 184.0, "discounted_cash": 25.0, "minimum": 9.28, "maximum": 184.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 30.3, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 38.63 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 26.51, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.28 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 23.99, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.28 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 25.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 25.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 34.09, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 35.35, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.91, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.15, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "fee schedule", "standard_charge_dollar": 25.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 39.14, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.28 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 184.0 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 29.04, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 184.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.28 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 27.78, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 36.61 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 26.51, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.74 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.51, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 37.88, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.74 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.01, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 26.01, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.51, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Commercial", "methodology": "fee schedule", "standard_charge_dollar": 25.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 29.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 25.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.28 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 25.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 30.3 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 31.56, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 25.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 184.0 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.01, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "HC BLOOD TYPING, ABO", "code_information": [ { "code": "86900", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 205.0, "discounted_cash": 141.0, "minimum": 3.0, "maximum": 205.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 170.24, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4.57 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 141.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 148.96, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.11 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 134.78, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.11 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 141.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 141.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 191.52, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 198.62, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 205.0, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 141.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 141.87, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "fee schedule", "standard_charge_dollar": 141.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 205.0, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.11 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 48.82 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 141.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 163.15, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Medicare", "methodology": "fee schedule", "standard_charge_dollar": 141.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 41.11 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.11 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 141.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 156.06, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 141.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4.34 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 141.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 148.96, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.27 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 148.96, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 205.0, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.27 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 146.13, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 146.13, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "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": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Commercial", "methodology": "fee schedule", "standard_charge_dollar": 141.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 141.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 141.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 141.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.11 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 141.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 141.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3.59 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 177.34, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 141.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 141.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 141.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 48.82 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 146.13, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "HC CLOT INHIB PROTEIN S,FREE", "code_information": [ { "code": "85306", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 882.0, "discounted_cash": 15.0, "minimum": 3.11, "maximum": 705.6, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 18.38, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 23.44 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 16.09, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.11 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 14.55, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.11 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 20.68, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 21.45, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 24.82, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.19, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 23.75, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.11 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 199.2 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.62, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 167.74 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.11 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 16.85, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 22.21 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 16.09, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.27 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.09, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 22.98, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.27 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.78, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 15.78, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "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": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.11 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.38 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.15, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 199.2 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.78, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "HC CYTOMEG DNA QUANT", "code_information": [ { "code": "87497", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 643.0, "discounted_cash": 42.0, "minimum": 25.704, "maximum": 514.4, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 51.41, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 65.55 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 42.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 44.98, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.14 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 40.7, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.14 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 42.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 42.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 57.83, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 59.98, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 69.4, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 42.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.7, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "fee schedule", "standard_charge_dollar": 42.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 66.4, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.14 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 42.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 49.27, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Medicare", "methodology": "fee schedule", "standard_charge_dollar": 42.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.14 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 42.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 47.12, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 42.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 62.12 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 42.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 44.98, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.65 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 44.98, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 64.26, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.65 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 44.13, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 44.13, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "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": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Commercial", "methodology": "fee schedule", "standard_charge_dollar": 42.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 42.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 50.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 42.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 42.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.14 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 42.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 42.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 51.41 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 53.55, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 42.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 42.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 42.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 44.13, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "HC B CELLS, TOTAL COUNT", "code_information": [ { "code": "86355", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 164.0, "discounted_cash": 37.0, "minimum": 22.638, "maximum": 131.2, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 45.28, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 57.73 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 37.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 39.62, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28.71 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 35.84, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28.71 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 37.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 37.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 50.94, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 52.82, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 61.12, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 37.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.64, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "fee schedule", "standard_charge_dollar": 37.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 58.48, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28.71 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 37.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 43.39, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Medicare", "methodology": "fee schedule", "standard_charge_dollar": 37.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28.71 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 37.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 41.5, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 37.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 54.71 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 37.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 39.62, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.15 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 39.62, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 56.6, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.15 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.86, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 38.86, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 39.62, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Commercial", "methodology": "fee schedule", "standard_charge_dollar": 37.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 37.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 44.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 37.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 37.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 28.71 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 37.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 37.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 45.28 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 47.16, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 37.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 37.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 37.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.86, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "HC BLOOD TYPING, RH (D)", "code_information": [ { "code": "86901", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 42.0, "discounted_cash": 39.0, "minimum": 3.11, "maximum": 42.0, "payers_information": [ { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 42.0, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.11 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 42.0 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 39.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 42.0, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Medicare", "methodology": "fee schedule", "standard_charge_dollar": 39.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 37.37 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.11 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 39.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 42.0, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 39.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4.34 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 39.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 41.81, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.27 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 41.81, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 42.0, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.27 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 41.01, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 41.01, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 41.81, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Commercial", "methodology": "fee schedule", "standard_charge_dollar": 39.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 39.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 39.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 39.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.11 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 39.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 39.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3.59 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 42.0, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 39.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 39.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 39.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 42.0 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 41.01, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 42.0, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4.57 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 39.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 41.81, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.11 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 37.83, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 3.11 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 39.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 39.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 42.0, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 42.0, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 42.0, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 39.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 39.82, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "fee schedule", "standard_charge_dollar": 39.82, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC COLLECT BLD ESTABLISHED CATH", "code_information": [ { "code": "36592", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 392.0, "discounted_cash": 141.0, "minimum": 31.96, "maximum": 313.6, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 170.24, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 141.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 148.96, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 65.14 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 134.78, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 65.14 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 141.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 141.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 191.52, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 198.62, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 229.83, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 141.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 141.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "fee schedule", "standard_charge_dollar": 141.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 219.9, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 65.14 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 141.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 163.15, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Medicare", "methodology": "fee schedule", "standard_charge_dollar": 141.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 65.14 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 141.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 156.06, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 141.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 141.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 148.96, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 68.4 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 148.96, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 212.81, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 68.4 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 146.13, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 146.13, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "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": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Commercial", "methodology": "fee schedule", "standard_charge_dollar": 34.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 141.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 34.33 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 141.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 141.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 65.14 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 141.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 141.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 177.34, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 141.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 31.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 141.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 146.13, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "HC DEBRIDE SKIN SUB-Q TISS MUSCLE =<20 SQ CM", "code_information": [ { "code": "11043", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2214.0, "discounted_cash": 788.0, "minimum": 157.24, "maximum": 9286.4, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 945.74, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1020.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 788.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 827.53, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 748.71, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 788.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 788.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 1063.96, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 1103.37, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1276.75, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 788.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 2214.0 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 788.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "fee schedule", "standard_charge_dollar": 788.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 1221.59, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 788.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 906.34, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Medicare", "methodology": "fee schedule", "standard_charge_dollar": 788.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 788.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 866.93, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 788.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 1500.0 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 788.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 827.53, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 827.53, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1182.18, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 811.76, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 811.76, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 827.53, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Commercial", "methodology": "fee schedule", "standard_charge_dollar": 157.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 788.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 157.24 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 788.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 788.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 330.89 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 788.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 788.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 985.15, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 788.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 788.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 788.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 811.76, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "HC BACTERIA IDENTIFICATION, AEROBIC ISOLATE", "code_information": [ { "code": "87077", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 50.0, "discounted_cash": 8.0, "minimum": 4.848, "maximum": 50.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 9.7, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.36 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 8.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.41 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 7.68, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.41 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 8.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 8.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 10.91, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 11.31, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 13.09, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.85, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "fee schedule", "standard_charge_dollar": 8.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 12.52, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.41 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 50.0 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.29, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 50.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.41 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 8.89, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.72 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 8.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.78 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.48, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.12, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.78 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.32, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 8.32, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "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": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 8.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 7.41 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.7 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.1, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 8.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 50.0 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.32, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "HC BRCA1 & BRCA2 FULL SEQ ANALYS/FULL DUP/DEL ANALYS", "code_information": [ { "code": "81162", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8040.0, "discounted_cash": 1824.0, "minimum": 1094.928, "maximum": 6432.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 2189.86, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2792.07 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1824.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 1916.12, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1638.39 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 1733.64, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1638.39 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 1824.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 1824.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 2463.59, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 2554.83, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2956.31, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1824.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1094.93, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "fee schedule", "standard_charge_dollar": 1824.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 2828.56, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1638.39 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1824.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2098.61, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1824.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1638.39 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1824.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 2007.37, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1824.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2646.08 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1824.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 1916.12, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1720.31 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1916.12, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2737.32, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1720.31 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1879.63, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 1879.63, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1916.12, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1824.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1824.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1824.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1824.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1638.39 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1824.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1824.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2189.86 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2281.1, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1824.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 1824.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1824.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1879.63, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "HC COLORECTAL CANCER SCREEN, SIGMOID, BA ENEMA - 74270 - 32000239", "code_information": [ { "code": "74270", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 533.0, "discounted_cash": 187.0, "minimum": 101.81, "maximum": 533.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 224.45, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 187.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 196.39, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 102.63 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 177.69, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 102.63 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 187.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 187.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 252.5, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 261.86, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 303.0, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 187.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 187.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "fee schedule", "standard_charge_dollar": 187.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 289.91, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 102.63 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 533.0 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 187.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 215.1, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Medicare", "methodology": "fee schedule", "standard_charge_dollar": 187.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 465.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 102.63 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 187.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 205.74, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 187.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 225.0 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 187.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 196.39, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 107.76 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 196.39, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 280.56, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 107.76 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 192.65, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 192.65, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 196.39, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Commercial", "methodology": "fee schedule", "standard_charge_dollar": 101.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 187.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 101.81 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 187.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 187.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 102.63 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 187.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 187.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 400.55 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 233.8, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 187.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 187.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 187.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 533.0 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 192.65, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "HC DEHYDROEPIANDROSTERONE-SULFATE", "code_information": [ { "code": "82627", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 218.0, "discounted_cash": 22.0, "minimum": 9.28, "maximum": 210.57, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 26.68, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 34.01 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 23.34, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.28 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 21.12, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.28 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 22.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 22.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 30.01, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 31.12, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 36.01, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.34, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "fee schedule", "standard_charge_dollar": 22.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 34.46, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.28 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 210.57 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 25.56, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 177.32 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.28 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 24.45, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 32.23 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 23.34, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.74 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.34, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 33.35, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.74 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.9, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 22.9, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "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": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Commercial", "methodology": "fee schedule", "standard_charge_dollar": 22.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 26.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 22.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 9.28 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 22.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 26.68 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 27.79, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 22.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 210.57 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.9, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "HC BASIC METABOLIC PANEL CALCIUM TOTAL", "code_information": [ { "code": "80048", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 422.0, "discounted_cash": 8.0, "minimum": 5.076, "maximum": 337.6, "payers_information": [ { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 8.88, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.35 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 8.04, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.35 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 8.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 8.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 11.42, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 11.84, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 13.71, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.08, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "fee schedule", "standard_charge_dollar": 8.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 13.11, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.35 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 171.67 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.73, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 144.56 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.35 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 9.31, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.27 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 8.88, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.67 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.88, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.69, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.67 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.71, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 8.71, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.88, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 8.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 6.35 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10.15 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.58, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 8.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 171.67 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.71, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 10.15, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.94 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.46, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "HC BRONCHOSCOPY DIAG", "code_information": [ { "code": "31622", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2316.0, "discounted_cash": 1898.0, "minimum": 133.94, "maximum": 2316.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 2277.62, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1020.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1898.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 1992.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1554.13 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 1803.12, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1554.13 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 1898.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 1898.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 2316.0, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 2316.0, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2316.0, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1898.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna", "plan_name": "Cigna Commercial", "methodology": "case rate", "standard_charge_dollar": 2316.0 }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1898.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "fee schedule", "standard_charge_dollar": 1898.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 2316.0, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1554.13 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1898.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2182.72, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1898.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1554.13 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1898.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 2087.82, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1898.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "case rate", "standard_charge_dollar": 1400.0 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1898.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 1992.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1631.84 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1992.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2316.0, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1631.84 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1954.96, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 1954.96, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1992.92, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Commercial", "methodology": "fee schedule", "standard_charge_dollar": 133.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1898.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 133.94 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1898.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 1898.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Standard EAPG Logic - Contracts", "plan_name": "EAPG Logic (Accounts not processed through 3M)", "methodology": "fee schedule", "standard_charge_dollar": 1553.35 }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1554.13 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1898.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1898.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2316.0, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1898.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 1898.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1898.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1954.96, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "HC COMPATIBILITY TEST,SPIN TECH", "code_information": [ { "code": "86920", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 252.0, "discounted_cash": 181.0, "minimum": 33.0, "maximum": 252.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 218.02, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 50.64 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 181.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 190.76, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 113.96 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 172.6, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 113.96 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 181.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 181.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 245.27, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 252.0, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 252.0, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 181.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 181.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "fee schedule", "standard_charge_dollar": 181.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 252.0, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 113.96 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 136.93 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 181.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 208.93, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Medicare", "methodology": "fee schedule", "standard_charge_dollar": 181.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 115.31 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 113.96 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 181.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 199.85, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 181.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 181.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 190.76, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 119.66 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 190.76, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 252.0, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 119.66 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 187.13, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 187.13, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "plan_name": "Provider Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 190.76, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Commercial", "methodology": "fee schedule", "standard_charge_dollar": 181.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 181.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 33.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 181.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 181.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 113.96 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 181.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 181.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 205.63 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 227.1, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 181.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 93.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 181.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 136.93 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 187.13, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "HC DETECT AGENT NOS, DNA, AMP", "code_information": [ { "code": "87798", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 117.0, "discounted_cash": 35.0, "minimum": 21.054, "maximum": 93.6, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 42.11, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 53.69 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 36.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.14 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 33.34, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.14 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 47.37, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 49.13, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 56.85, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.05, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 54.39, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.14 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 40.35, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.14 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 38.6, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 50.88 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 36.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.65 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.84, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 52.64, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 31.65 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.14, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 36.14, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "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": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Commercial", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 41.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 30.14 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 42.11 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 43.86, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.14, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "HC BETA 2 GLYCOPROTEIN I ANTIBODY,EA", "code_information": [ { "code": "86146", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 94.0, "discounted_cash": 25.0, "minimum": 8.1, "maximum": 94.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 30.54, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "fee schedule", "standard_charge_dollar": 38.94 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 26.72, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.1 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 24.18, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.1 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 34.36, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 35.63, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 41.23, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Cigna Healthspring", "plan_name": "Cigna Healthspring Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.27, "additional_payer_notes": "Laboratory - 60.00% of Medicare Rates" }, { "payer_name": "Clear Spring Health of Illinois", "plan_name": "Clear Spring Health of Illinois", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clifton Health Systems", "plan_name": "Clifton Health Systems Employer EPO", "methodology": "fee schedule", "standard_charge_dollar": 39.45, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "CountyCare", "plan_name": "CountyCare Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.1 }, { "payer_name": "Coventry", "plan_name": "Coventry Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 94.0 }, { "payer_name": "Devoted Health", "plan_name": "Devoted Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Commercial", "methodology": "fee schedule", "standard_charge_dollar": 29.27, "additional_payer_notes": "115.00% of Medicare Rates" }, { "payer_name": "Essential Health Partners", "plan_name": "Essential Health Partner Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Link, Inc.", "plan_name": "Health Link, Inc. Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 94.0 }, { "payer_name": "Humana", "plan_name": "Humana Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.1 }, { "payer_name": "Humana", "plan_name": "Humana Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Humana", "plan_name": "Humana Medi-Medi", "methodology": "fee schedule", "standard_charge_dollar": 28.0, "additional_payer_notes": "110.00% of Medicare Rates" }, { "payer_name": "Illinois Physicians Alliance", "plan_name": "Illinois Physicians Alliance Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imagine Health Network", "plan_name": "Imagine Health Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 36.9 }, { "payer_name": "Longevity Health Plan of Illinois", "plan_name": "Longevity Health Plan of Illinois Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 26.72, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Meridian", "plan_name": "Meridian Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.51 }, { "payer_name": "Meridian", "plan_name": "Meridian Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.72, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 38.18, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.51 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.21, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare (MAPD) MA-SNP FIDE-SNP Medi Medi", "methodology": "fee schedule", "standard_charge_dollar": 26.21, "additional_payer_notes": "103.00% of Medicare Rates" }, { "payer_name": "Provider Partners Health Plan (PPHP)", "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": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Commercial", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Ravenswood Physicians Associates IPA", "plan_name": "Ravenswood Physicians Associates IP Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physician Provider Group IPA Commercial", "methodology": "fee schedule", "standard_charge_dollar": 30.0 }, { "payer_name": "Resurrection Physicians Provider Group IPA", "plan_name": "Resurrection Physicians Provider Group IPA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Self-Pay", "plan_name": "Self-Pay (100% of MCR)", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicaid", "plan_name": "Traditional Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 8.1 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Commercial", "methodology": "fee schedule", "standard_charge_dollar": 30.54 }, { "payer_name": "UHC", "plan_name": "UHC Exchange", "methodology": "fee schedule", "standard_charge_dollar": 31.81, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "UHC", "plan_name": "UHC VA", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Behavioral Health", "plan_name": "United Behavioral Health Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers comp", "plan_name": "Workers Comp", "methodology": "fee schedule", "standard_charge_dollar": 94.0 }, { "payer_name": "Zing Health Provider Network", "plan_name": "Zing Health Povider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.21, "additional_payer_notes": "103.00% of Medicare Rates" } ] } ] }, { "description": "HC BX BREAST W DEVICE US GUIDE 1ST LESION", "code_information": [ { "code": "19083", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5453.0, "discounted_cash": 1761.0, "minimum": 146.1, "maximum": 4550.0, "payers_information": [ { "payer_name": "Access Community Health Network", "plan_name": "Access Community Health Network Commercial HMO", "methodology": "fee schedule", "standard_charge_dollar": 2113.45, "additional_payer_notes": "120.00% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Commercial", "methodology": "case rate", "standard_charge_dollar": 1020.0 }, { "payer_name": "Aetna", "plan_name": "Aetna Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 1849.27, "additional_payer_notes": "105.00% of Medicare Rates" }, { "payer_name": "Aetna Better Health", "plan_name": "Aetna Better Health Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1153.64 }, { "payer_name": "BCBS", "plan_name": "BCBS Dual Eligible", "methodology": "fee schedule", "standard_charge_dollar": 1673.15, "additional_payer_notes": "95.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicaid", "methodology": "fee schedule", "standard_charge_dollar": 1153.64 }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare HMO", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Medicare PPO", "methodology": "fee schedule", "standard_charge_dollar": 1761.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS MY BLUE PLUS POS", "methodology": "fee schedule", "standard_charge_dollar": 2377.63, "additional_payer_notes": "135.00% of Medicare Rates" }, { "payer_name": "BCBS", "plan_name": "BCBS Smart Health Care", "methodology": "fee schedule", "standard_charge_dollar": 2465.69, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Celtic (Ambetter)", "plan_name": "Celtic Insurance Company (Ambetter) Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2853.16, "additional_payer_notes": "162.00% of Medicare Rates" }, { "payer_name": "Celtic (WellCare)", "plan_name": "Celtic WellCare Complete (WellCare) Medicare", "met